Syphilis Causing Lichenoid Esophagitis

We present a 50-year-old woman with human immunodeficiency virus admitted to the hospital for melenic stools and anemia who underwent esophagogastroduodenoscopy for evaluation of upper gastrointestinal bleed. She is found to have inflammation of the esophagus with ulcerations and crater formation. A biopsy reveals severe inflammation with lymphocytic infiltrates with civatte bodies suggestive of lichenoid esophagitis with the presence of spirochetes (Treponema pallidum). The presence of syphilis in the esophagus causing lichenoid esophagitis is an extremely rare presentation that has never been reported.