Stents and Surprises: A Case of Intriguing Multi-site Infections

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Esophageal stenting, while considered a safe procedure, can lead to a range of complications including mucosal erosion, stent migration, aspiration pneumonia, and perforation. While localized infections, such as pneumonia, are uncommon after stenting, disseminated infections without esophageal perforation are even rarer. This case involves a 54-year-old male with a history of dysphagia due to an esophageal stricture, initially treated with esophageal stent. However, the stent was removed after two weeks due to chest pain thought to be odynophagia. One week post-removal, he presented to the emergency department with recurrent central chest pain and a fever of 103F. Chest computed tomography (CT) showed no evidence of esophageal perforation but revealed a 6.7 cm subcarinal mass, prompting an endobronchial ultrasound with biopsy, which was negative for malignancy. Two days later, the patient developed a headache, behavioral changes, and confusion. Head CT demonstrated a 9 mm mass in the right frontal lobe with a left midline shift. Around this time, cultures from mediastinal lymph node tissue returned positive for Streptococcus intermedius. The patient was started empirically on ceftriaxone, metronidazole, and micafungin. A transesophageal echocardiogram showed no evidence of infective endocarditis. He subsequently underwent a craniotomy with abscess drainage; cultures grew Streptococcus anginosus and Fusobacterium nucleatum. During the admission, the patient also underwent cervical mediastinoscopy to investigate the subcarinal mass further, revealing purulent necrosis with cultures positive for Candida species and Lactobacillus. After a thirty-seven-day hospital stay, the patient was discharged with a six-week course of IV penicillin and micafungin, then transitioned to oral amoxicillin. Follow-up MRI revealed brain enhancement indicating phlegmon, ventriculitis, and hydrocephalus of the right lateral ventricle. The patient required external ventricular drain placement, which was later replaced by a ventriculoperitoneal shunt, and received an additional eight weeks of IV ceftriaxone. Follow-up CT imaging showed improvement in both the central nervous system and mediastinal infections. This case illustrates a rare association between esophageal stenting and multi-site infections with severe CNS involvement. The unusual mix of pathogens in an immunocompetent patient, absent of esophageal perforation, adds to the intrigue. The dissemination route remains unclear, as there was no evidence of infective endocarditis to suggest septic emboli, hinting instead at a possible lymphatic spread.

Volume

211

First Page

A6653

Last Page

A6653

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A6653

ISSN

1535-4970

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