A 76-year-old male with a past medical history of end-stage renal disease, heart failure requiring left ventricular assist device, chronic obstructive pulmonary disease, obesity, hypertension, and recurrent gastrointestinal bleeds due to arterio-venous malformations was seen by gastroenterology for anemia. Hemoglobin was 7.6. Pt reportedly was having dark brown stools without melena or hematochezia at that time. Esophagogastroduodenoscopy (EGD) was performed, and the patient was found to have a blue discoloration of the esophagus, documented in the upper 1/3, middle 1/3, and lower 1/3 of the esophagus. Of note, pt was nil per os prior to his procedure. EGD four months prior did not report any blue discoloration of the esophagus.

Discussion: When reviewing the literature, there is one case report documenting blue discoloration of the esophagus found to be associated with ingestion of Urelle tablets [1]. Per this patient’s medical chart and verbal history, he was not taking Urelle tablets. His medication regimen at the time included albuterol, allopurinol, amlodipine, atorvastatin, benzonatate, brimonidine, docusate, escitalopram, fluticasone, hydralazine, ketoconazole, levothyroxine, nystatin, omega-3 fatty acids, ondansetron, pantoprazole, potassium chloride, sildenafil, tamsulosin, torsemide, and warfarin. There are no reported associations with any of these medications and discoloration of the esophagus. The ultimate etiology of this patient’s case is unknown currently.