Esophageal perforation associated with a single dose of bisphosphonate

A 77-year-old Japanese woman with cervical dystonia was admitted to our institution for steroid therapy acute hepatitis secondary autoimmune hepatitis. We prescribed oral bisphosphonates prevent steroid-induced osteoporosis. Six days after the first dose of bisphosphonate, patient complained pharyngeal and back pain. Upper gastrointestinal endoscopy revealed an ulcer in esophagus (Figure A). Computed tomography circumferential edema over entire length free air around esophageal wall B C). Emergency surgery a 3-cm perforation abscess D). The inflammation improved surgery, she able ingest nutrition orally. Although injury from has been reported often, associated single bisphosphonate rarely. Esophageal patients diverticulum or hiatal hernia. In case, likely owing tablet retention dystonia. summary, we report risk severe complications stress that caution is needed their use.