Acute Diffuse Phlegmonous Esophagitis Involving the Entire Esophagus with Septic Shock: A Case Report and Literature Review

Background: Acute diffuse phlegmonous esophagitis is a relatively rare bacterial inflammation of the esophagus. It is characterized by an acute, diffuse, purulent infection involving the submucosal and serosal layers, resulting in phlegmonous-like features. There are only a few case reports in the medical literature, and early diagnosis of this condition presents challenges. Case Presentation: This report presents a 73-year-old male patient with a history of type 2 diabetes, hypertension, gout, and chronic alcohol use, with poorly controlled blood glucose. The patient presented with upper abdominal pain, fever, shortness of breath, and dysphagia. Initial symptoms included severe upper abdominal pain, fever, and respiratory distress. Chest and abdominal enhanced CT scans revealed thickening and swelling along the entire esophagus, with narrowing of the lumen. After contrast enhancement, the esophagus showed ring-like enhancement. Upper gastrointestinal endoscopy showed mucosal swelling. There was no ulceration or perforation. The diagnosis of acute diffuse phlegmonous esophagitis was considered after excluding other common acute abdominal and chest pain conditions. The condition progressed rapidly, leading to septic shock. Next-Generation Sequencing of blood was positive for hypervirulent Klebsiella pneumoniae (hvKp). Despite active treatment, the patient’s condition was initially controlled; however, a follow-up chest CT showed multiple air pockets around the esophagus. The patient subsequently developed septic shock again and died despite active treatment. Conclusion: Hypervirulent Klebsiella pneumoniae infection causing acute diffuse phlegmonous esophagitis involving the entire esophagus is a rapidly progressing condition that can quickly lead to septic shock. This report aims to alert clinicians to this rare disease and emphasizes the need for heightened awareness in cases of severe upper abdominal pain, where atypical abdominal pain may mask potentially fatal chest pain conditions. Early and accurate diagnosis and timely treatment are essential.