38 year-old man who presented with severe odynophagia and dysphagia to both solids and liquids. Endoscopy revealed three ulcers: a distal esophageal ulcer measuring 2.5 cm diameter 1.5 above the esophagogastric junction (left), a raised 1 cm ulcer in the midesophagus (center), and another large ulcer measuring 3 cm in greatest diameter located 2 cm below the upper esophageal sphincter (right). Multiple biopsies and brushings, obtained at two separate endoscopies, showed no cytologic, histologic or culture evidence for any pathogens or for neoplasia.