Rolling on the spikes

Excerpt

A 64-year-old male with a past medical history significant for osteoarthritis, gastroesophageal disease, and psoriatic arthritis presented to the Rheumatology-Dermatology clinic for a follow-up visit with a 3-month history of progressive dysphagia to solid and liquid with an unintentional 20-lb weight loss. Physical exam was unremarkable with no oropharynx abnormalities, enlarged thyroid gland, or cranial nerve abnormalities. Skin and musculoskeletal exams were without psoriasis and inflammatory arthritis respectively. Malignancy and infectious work-up including complete blood count, serum protein electrophoresis (SPEP)/urine protein electrophoresis (UPEP), human immunodeficiency virus (HIV), and computed tomography (CT) of the neck, chest, abdominal, and pelvis were within normal limits per radiology report at the time. He underwent an upper esophagogastroduodenoscopy (EGD) with mucosal biopsies of the middle and distal esophagus showing a hiatal hernia with chronic inflammation at the distal esophagus, but no evidence of obstructing lesions, malignancy, or infectious etiologies. …