A case of esophageal perforation associated with pharyngotonsillitis and Streptococcus anginosus group infection.
Narumi Deguchi, Masatoshi Nakagawa, Noboru Inoue et al.
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Case in brief
A previously healthy 60-year-old man developed progressive right-sided chest pain after pharyngotonsillitis. Although initial chest radiography was unremarkable, computed tomography after clinical deterioration showed right empyema and an intramural esophageal abscess. Endoscopy revealed extensive circumferential ulceration with purulent discharge, and pleural fluid grew Streptococcus constellatus, a member of the Streptococcus anginosus group. With worsening respiratory status and a severely infected, fragile esophageal wall despite drainage and broad-spectrum antibiotics, he underwent thoracoscopic total thoracic esophagectomy followed by delayed gastric-conduit reconstruction. His postoperative course was favorable.
What made this case unusual
The case describes severe esophageal perforation and empyema associated with streptococcal pharyngotonsillitis in an immunocompetent patient, rather than the more usual causes of perforation such as foreign-body ingestion, procedures, or spontaneous rupture.
Diagnostic / clinical pearl
A normal initial chest radiograph did not exclude evolving esophageal infection: clinical deterioration prompted CT that identified empyema and an intramural abscess. Progressive symptoms after pharyngotonsillitis warrant attention to possible deep thoracic complications.