An 82-year-old female with a history of osteoporosis and achalasia treated with periodic botulinum toxin injections presented a few weeks after the last session, reporting dysphagia and retrosternal pain. An upper gastrointestinal endoscopy revealed mucosal involvement in the middle and lower third of the esophagus in the form of edema, friability, exudate and extensive superficial ulcers, which converged distally and extended around the entire circumference. The cardia was punctiform, but could be passed without difficulty.