Cerebral abscess secondary to post-esophageal dilation bacteremia: A case report with a pathophysiological association to consider

Background Accidental caustic ingestion is a pediatric emergency that may result in severe esophageal injury and long-term complications, including strictures requiring repeated dilation. Cerebral abscess is a rare but potentially fatal condition in children and has only sporadically been reported following esophageal dilation. Case presentation We report the case of a 3-year-old girl who developed an esophageal stricture following accidental ingestion of sodium hydroxide. After multiple esophageal dilations, the patient presented with electrolyte abnormalities and neurological symptoms. Neuroimaging revealed a large left frontotemporal cerebral abscess with mass effect. Surgical drainage was performed, and Streptococcus intermedius was isolated from the abscess cultures. Prolonged targeted antimicrobial therapy led to clinical stabilization, although residual neurological deficits persisted. Conclusion This case highlights a rare but severe complication associated with repeated esophageal dilation in pediatric patients. Transient bacteremia caused by mucosal trauma, combined with hematogenous dissemination through the Batson venous plexus, may explain cerebral seeding. Increased clinical vigilance in children with fever and early neuroimaging are crucial if any neurological symptoms develop after esophageal dilation.