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 colony-stimulating 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.

Fig. 1

An enhanced computed tomography (CT) scan conducted on the day of onset showing diffuse thickening of the esophagus and edematous enlargement of the posterior mediastinum with bilateral pleural effusions. Sections are shown at the level of the cervical esophagus (a), the thoracic inlet (b), the mid-esophagus (c), and the lower esophagus (d). Note the low attenuation surrounded by a peripheral enhancing rim (b)

Fig. 2

Esophagogastrography using water-soluble contrast medium injected through a nasogastric tube showed no evidence of esophageal perforation

Fig. 3

A follow-up computed tomography (CT) scan performed on the 15th day from the onset demonstrating the improvement in the diffuse esophageal wall thickening

Fig. 4

Upper gastrointestinal endoscopy performed on the 32nd day from the onset showing the esophageal mucosa peeling and pseudolumen formation (an arrow)

Fig. 5

Upper gastrointestinal endoscopy performed on the 95th day from the onset showing an ulcer (an arrow) and circular stricture of the mid-esophagus with disappearance of the pseudolumen that had been observed previously