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Peer-reviewedCC BY-NCJournal of surgical case reports

Non-traumatic acute mediastinitis secondary to acute phlegmonous esophagitis: a rare case report.

  • Meron H Biza1
  • Eyerusalem K Degife2
  • Selamawit Z Tadesse3
  • Chernet T Mengistie3
  • Ephrem M Atsbha1
  • Biruk T Mengistie3
  1. 1Department of Emergency and Critical Care, Washington Medical Center, Rwanda Street, Bole District, Addis Ababa 1000, Ethiopia.
  2. 2Department of Internal Medicine, Washington Medical Center, Rwanda Street, Bole District, Addis Ababa 1000, Ethiopia.
  3. 3School of Medicine, College of Health Sciences, Addis Ababa University, Zambia Street, Lideta District, Addis Ababa 1000, Ethiopia.
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Abstract

Acute mediastinitis secondary to acute phlegmonous esophagitis (APE) is an exceptionally rare, life-threatening condition with high morbidity. We report a 75-year-old diabetic female with recent severe pneumonia who presented with pleuritic chest pain, dyspnea, and elevated inflammatory markers. Computed tomography pulmonary angiography excluded embolism but revealed diffuse long-segment esophageal wall thickening with mediastinal fat stranding, aortic encasement, and pleural effusion, features consistent with APE and secondary non-traumatic mediastinitis without overt perforation. Given clinical stability, endoscopy was deferred to avoid disrupting a possible contained micro-perforation. The patient was successfully managed with 14 days of empiric broad-spectrum intravenous antibiotics (vancomycin, cefepime, metronidazole), achieving complete clinical and radiographic resolution. This case underscores that in hemodynamically stable patients without free perforation or large abscess, conservative antimicrobial therapy can be definitive. It also highlights the importance of considering APE in non-surgical patients presenting with acute chest pain.

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Cite

BibTeXRIS
BibTeX
@article{biza2026nontraumatic,
  title = {{Non-traumatic acute mediastinitis secondary to acute phlegmonous esophagitis: a rare case report.}},
  author = {Meron H Biza and Eyerusalem K Degife and Selamawit Z Tadesse and Chernet T Mengistie and Ephrem M Atsbha and Biruk T Mengistie},
  journal = {Journal of surgical case reports},
  year = {2026},
  month = oct,
  doi = {10.1093/jscr/rjag947},
  url = {https://europepmc.org/article/MED/42898990},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Non-traumatic acute mediastinitis secondary to acute phlegmonous esophagitis: a rare case report.
AU  - Meron H Biza
AU  - Eyerusalem K Degife
AU  - Selamawit Z Tadesse
AU  - Chernet T Mengistie
AU  - Ephrem M Atsbha
AU  - Biruk T Mengistie
PY  - 2026
DA  - 2026/10/19
JO  - Journal of surgical case reports
DO  - 10.1093/jscr/rjag947
UR  - https://europepmc.org/article/MED/42898990
AB  - Acute mediastinitis secondary to acute phlegmonous esophagitis (APE) is an exceptionally rare, life-threatening condition with high morbidity. We report a 75-year-old diabetic female with recent severe pneumonia who presented with pleuritic chest pain, dyspnea, and elevated inflammatory markers. Computed tomography pulmonary angiography excluded embolism but revealed diffuse long-segment esophageal wall thickening with mediastinal fat stranding, aortic encasement, and pleural effusion, features consistent with APE and secondary non-traumatic mediastinitis without overt perforation. Given clinical stability, endoscopy was deferred to avoid disrupting a possible contained micro-perforation. The patient was successfully managed with 14 days of empiric broad-spectrum intravenous antibiotics (vancomycin, cefepime, metronidazole), achieving complete clinical and radiographic resolution. This case underscores that in hemodynamically stable patients without free perforation or large abscess, conservative antimicrobial therapy can be definitive. It also highlights the importance of considering APE in non-surgical patients presenting with acute chest pain.
SN  - 2042-8812
ER  -