A NEW PROBABLE INCREASING CAUSE OF ESOPHAGEAL ULCERATION - ALENDRONATE

We present a case of esophageal ulcerations caused by alendronate (Fos amax), a recently marketed medication. The patient presented with a ch ief complaint of retrosternal pain and severe odynophagia of 5 days du ration. She was taking prednisone 10 mg and azathioprine 100 mg p.o. q .d for systemic lupus erythematosus. To prevent osteoporosis, she was started on alendronate 10 mg q.d. 2 wk before her symptoms started, En doscopy of the upper GI tract revealed two deep, large ulcers at the g astroesophageal junction. Multiple biopsy specimens revealed necroinfl ammatory debris and acute esophagitis. However, no organisms mere iden tified, and the result of her HIV test (ELISA) was negative. Alendrona te was discontinued, and her symptoms resolved completely in 1 wk. Fol low-up endoscopy performed 4 wk later revealed complete healing of the ulcers.