A 14-year-old healthy male presented with 5 days of worsening odynophagia, dysphagia, and mid-sternal chest pain. He described poor appetite and feeling of "food getting stuck." On review of systems, 4 days prior he had fever, body aches and emesis. Pertinent physical findings included mild mid-epigastric tenderness and a small vesicular lesion on his right thumb. Contrast esophagram was normal.