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An esophageal pathologic examination showed no fungal, cytomegalovirus, or herpes virus infection, but acute ulceration with infiltration of neutrophils and eosinophils was noted ( Fig. Furthermore, the upper gastric body showed the same findings. In the area where cardia swelling was noted on CT, findings of verrucous gastritis were observed via gastrointestinal endoscopy without any acute mucosal changes. The esophagogastroduodenoscopy showed multiple deep and longitudinal ulcers with concurrent hemorrhage and denudation along the entire esophagus ( Fig. The swelling of the esophagus was later documented to be severely ulcerated with a hemorrhagic mucosal injury (A inlet) and that of gastric cardia to be verrucous gastritis with chronic inflammation (B inlet, arrows). The image showed swelling in the distal esophagus (A, arrowheads) and gastric cardia (B, arrowheads). 1).Ĭontrast enhanced abdominal computed tomography image of the patient. Contrast-enhanced chest and abdomen computed tomography (CT) was performed and swelling in the distal esophagus and gastric cardia was noted ( Fig. Other laboratory findings including coagulation test and electrolytes were normal. C-reactive protein was elevated to 9.81 mg/dL, and the initial hemoglobin level was 16.1 g/dL. Initial laboratory tests showed mild leukocytosis (20,700/mm 3) with 79% segmented neutrophils, 8% lymphocytes, and 11% monocytes. The manufacturer recommended a 3:1 dilution of water and vinegar before drinking. The acidity of this beverage was 2.7% with a pH of 2.6, and it was composed of acetic acid (35%), citric acid (60%), and maleic acid (5%) in the form of organic acids. He had been habitually drinking more than half a cup (100–150 mL) of a pomegranate-fermented vinegar beverage with no sufficient dilution every morning for 1 month. He was hemodynamically stable, with a clear mental state. Therefore, vinegar beverages should be considered as corrosive agents.Ī 15-year-old boy presented with severe pain at the substernal and epigastric areas with tenderness, vomiting, and hematemesis for 2 weeks. Overall, continuous consumption of a vinegar beverage can result in acidic burns and destruction of the surface of the upper gastrointestinal tract. The follow-up endoscopy showed improvement of the esophageal injuries. The patient was treated with corticosteroid, antibiotic therapy, and mucosa protecting alginate medication and was asked to fast for a week. He had been drinking a vinegar beverage daily without sufficient dilution. Multiple longitudinal ulcers, concurrent mucosal hemorrhage, and denuded mucosa were noted in the whole of the esophagus via an endoscopic examination. A 15-year-old male visited the emergency room presenting with hematemesis and severe epigastric pain. We report a case of corrosive esophageal ulcer found in an adolescent consuming a vinegar drink daily. Although gastroesophageal damage is commonly induced by accidental drinking of a strong acid or alkali, damage due to the consumption of a vinegar beverage is not well known.