Gastric mucosal necrosis with vascular degeneration induced by doxycycline.
We encountered 2 patients who underwent esophagogastroduodenoscopy for epigastric abdominal pain, which showed gastric mucosal erosions covered with adherent exudate. Microscopic examination of biopsies from the lesions obtained from the 2 cases revealed characteristic pathologic abnormalities that shared striking similarities. These included superficial mucosal necrosis and capillary vascular degenerative change in a background of reactive or chemical gastropathy. Further review of records identified ongoing oral doxycycline use in both patients. After cessation of the drug both patients' symptoms resolved. A follow-up esophagogastroduodenoscopy in 1 patient showed normal gastric mucosa. This pattern of injury had not been previously described and seems to be characteristic for doxycycline-induced gastric mucosal toxicity. Recognition of the clinical, endoscopic, and pathologic features described here may facilitate prompt diagnosis and management of this condition.
Department of Pathology, University of Chicago Medical Center, Chicago, IL 60637, USA. syxiao@uchicago.edu
Shu-Yuan
SY
Xiao
Lei
L
Zhao
John
J
Hart
Carol E
CE
Semrad
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002196:Capillaries / Q000187:drug effects / Q000473:pathology; D004318:Doxycycline / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology; D016491:Peripheral Vascular Diseases / Q000139:chemically induced*; D012074:Remission Induction; D016896:Treatment Outcome; D028761:Withholding Treatment
D000900:Anti-Bacterial Agents; D004318:Doxycycline