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123 which showed erosions and sheets of sloughed mucosa from the incisors to the gastroesophage‐ al junction, suggestive of esophagitis dissecans superficialis (EDS), later confirmed on histopath‐ ological examination (FIGURE 1D). Her medication was discontinued, and she was treated with pan‐ toprazole, dexamethasone, and sucralfate. Direct immunofluorescence (DIF) staining was negative, with no observed reactants to immunoglobulins IgA, IgG, and IgM or complement C3. There was no clinical improvement and parenteral nutrition was necessary. Repeated endoscopy findings were identical; viral and fungal esophagitis were ruled out. A colonoscopy, prompted by acute hematoche‐ zia, was performed. A rectal mass was found, con‐ firmed to be adenocarcinoma on pathological ex‐ amination. Palliative care was provided. The patient died in the hospital, without regaining oral feeding. EDS is a rare endoscopic finding characterized by sloughing fragments of necrotic esophageal A 91 ‐year ‐old woman presented with buccal bleed‐ ing, odynophagia, and epigastric pain aggravat‐ ed by food intake. She reported an unintention‐ al weight loss of 8% in the previous months but no other symptoms. Oral examination revealed hemorrhagic erosions and areas of desquama‐ tion in the tongue and buccal mucosa (FIGURE 1A). No ocular, cutaneous, or genital lesions were ob‐ served, and there was no history of caustic sub‐ stance ingestion or the use of medication other than simvastatin and clopidogrel. The patient un‐ derwent esophagogastroscopy (FIGURE 1B and 1C), CLINICAL IMAGE

Esophagitis dissecans superficialis as the first manifestation of rectal adenocarcinoma