Endoluminal Vacuum-Assisted Closure Therapy for Pharyngocutaneous Fistula Caused by Transient Anti-Phospholipid Syndrome

A 67-year-old female with no underlying diseases presented to the emergency department with dyspnea and fever. Laboratory findings were remarkable for pancytopenia, neutropenia, and a positive lupus anticoagulant, a marker of antiphospholipid syndrome (APS). Physical examination revealed necrosis involving the distal portions of the right index and middle fingers, the entire epiglottis, and the right hypopharynx. Imaging studies showed enterocolitis and multiple splenic infarcts. Subsequent evaluation demonstrated cerebellar infarcts and multiple ulcerative lesions in the colon. These symptoms were attributed to thromboembolism, leading to a diagnosis of APS and prompting the initiation of anticoagulant therapy. The hypopharyngeal necrosis resulted in a pharyngocutaneous fistula, which was managed with endoluminal vacuum-assisted closure therapy. Secondary wound healing was then promoted through laser cauterization of the reduced defect area. One month after the surgery, complete healing of the hypopharyngeal defect was achieved.