Acute phlegmonous esophagitis as a rare but threatening complication of chemoradiotherapy: report of a case

Abstract

Phlegmonous infection involving the digestive tract has been reported to have a poor prognosis. However, the pathogenesis and clinical features of acute phlegmonous esophagitis have remained unclear due to the rarity of the disease. We herein report a case of acute phlegmonous esophagitis that showed a fulminant course during chemoradiotherapy for uterine cancer. The patient developed septic shock 10 h after postprandial nausea and vomiting, and a computed tomographic scan showed diffuse thickening of the esophageal wall. Severe leukopenia that was refractory to the administration of granulocyte colonystimulating factor persisted during the first few days. The patient fortunately survived after intensive treatment. The acute phlegmonous esophagitis of the present case might have been evoked and worsened by chemoradiotherapy due to its emetic and myelosuppressive adverse effects, respectively. Although its incidence is extremely rare, acute phlegmonous esophagitis may occur as a life-threatening complication of chemoradiotherapy.

Acute suppurative oesophagitis with fever and cough: A case report

“…Suppurative infections can affect any part of the gastrointestinal tract, most commonly the stomach, with inflammation involving the entire gastric cavity, but cases extending beyond the cardia or pylorus involving the oesophagus, small intestine and colon are rare[ 1 , 2 ]. Reports of simultaneous involvement of the oesophagus and stomach are very limited.…”

“…In this case, the suppurative inflammation of the patient extended from the oesophagus across the cardia to the lesser curvature of the stomach. The predisposing factors of suppurative oesophagitis include immunosuppression, alcoholism, peptic ulcer, chronic gastritis or other gastric mucosal lesions, gastric juice deficiency, infection, connective tissue diseases, and malignant tumours[ 2 , 3 ]. Physical and chemical factors such as foreign body or mechanical injury, severe vomiting, accidental use of corrosive agents, iatrogenic traumatic injury during gastroscopy, and consuming too much hot food may be involved.…”

“…Therefore, the early diagnosis and appropriate treatment of this disease is critical. If the lesion involves the mediastinum and the adjacent organs to form a fistula, conservative medical treatment alone may be ineffective, and surgical fistula repair or oesophagectomy may also be required[ 1 , 2 ]. We report a rare case of acute suppurative oesophagitis in a patient admitted for fever with productive cough and a significant history of lower oesophageal mucosal frostbite, who was successfully diagnosed and treated with repeated gastroscopy, appropriate antibiotics, and innovative symptomatic treatment.…”

Phlegmonous Esophagitis Treated with Internal Drainage and Feeding Jejunostomy

“…Moreover, the mortality rate for cases requiring surgical drainage and resection was 50% (13 of 26). Because surgical and medical management are both high-risk, the most effective treatment for acute phlegmonous esophagitis should be chosen depending on the clinical circumstances [ 1 , 5 – 7 ].…”

A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation

“…Acute phlegmonous esophagogastritis is a rare digestive tract disease that has been reported only rarely in the literature [ 1 – 13 ]. Acute phlegmonous esophagogastritis is a potentially fatal disease that may be combined with esophageal perforation, mediastinitis, peritonitis, and empyema.…”