# Fulminant Phlegmonitis of the Esophagus and Stomach

## TL;DR

This paper presents a fatal case of rare esophageal and stomach inflammation, emphasizing the need for early diagnosis and targeted treatment.

## Contribution

The paper highlights the diagnostic challenges and the importance of early endoscopic and microbiological evaluation in phlegmonous esophagogastritis.

## Key findings

- Nonspecific symptoms led to initial misdiagnosis of pancreatitis, delaying treatment.
- Endoscopy and CT imaging revealed severe inflammation, fistulas, and intramural gas.
- Co-infections with bacteria and viruses were identified, but treatment failed to prevent multi-organ failure.

## Abstract

Phlegmonous esophagogastritis is a rare and life-threatening condition characterized by purulent inflammation of the submucosal and muscularis layers of the esophagus and stomach. We report the case of a 59-year-old male with a history of hypertension and prior herbicide ingestion who presented with fever, sore throat, chest pain, and progressive abdominal pain. Initial misdiagnosis of pancreatitis delayed treatment. Endoscopy revealed extensive mucosal detachment, submucosal edema, purulent exudates, and fistula formation, while computed tomography (CT) demonstrated gastric wall thickening and intramural gas. Microbiological analysis identified Streptococcus spp., Epstein-Barr virus, and cytomegalovirus co-infections. Despite intensive therapy, including antibiotics, antivirals, nutritional support, and pleural drainage, the patient’s condition deteriorated, leading to multi-organ failure and death. This case highlights the diagnostic challenges posed by nonspecific symptoms of phlegmonous esophagogastritis, the critical importance of early endoscopic evaluation, and the value of microbiological analysis for tailored treatment. Early recognition and timely intervention are essential to improving outcomes for this potentially fatal condition.