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A 17 year old boy comes is brought in to the ED at 2am for severe retrosternal chest pain that awoke him from sleep. He was well prior to going to bed at 11:30pm, and denies fever, cough, radiation of the pain, vomiting, trauma, foreign body ingestion. He has a past medical history of appendectomy 8 months prior, acne for which he takes an oral antibiotic and uses a topical cream daily, and mild intermittent asthma for which he uses an inhaler once or twice a year “when the weather changes.” He is a straight A student applying to colleges currently. His physical examination is normal, as is a CXR and ECG. What is the probable cause of his chest pain?
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January 3, 2018 at 1:20 am
The answer is B. The patient likely takes doxycycline, and has pill esophagitis, commonly found when taking the doxycycline with insufficient water just before bed. Symptoms include retrosternal chest pain, often worse with swallowing. Other medications commonly found to cause this disorder include NSAIDs and iron. Treatment includes stopping the culprit medication until symptoms resolve, viscous lidocaine for severe pain, and sucralfate or liquid antacids. Patients should be advised to take their doxycycline with more water, and several hours before going to bed / lying flat.