Thoracic vertebral osteomyelitis secondary to chronic esophageal perforation

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Background Context Osteomyelitis secondary to perforation of the esophagus is a rare condition. Thoracic osteomyelitis after chronic esophageal perforation has never been described in the literature. Purpose We report a case of vertebral osteomyelitis resulting from a chronic esophageal perforation. Study Design/Setting Case report/University hospital. Methods A 52-year-old woman presented with dysphagia, severe mid back, and epigastric pain over a 6-week period. Endoscopic and radiological investigations revealed the presence of a paraspinal inflammatory mass protruding into the posterior esophageal wall. Two weeks after admission, the patient developed septic complications which required surgical intervention. This revealed the presence of an esophageal perforation and osteomyelitis of the T4–T5 and T7–T8 vertebrae. After T-tube closure of the esophageal perforation along with surgical debridement of the vertebrae and a 6-week course of antibiotics, the patient made a sound recovery. However, there was persistence of back pain with exaggerated thoracic spine kyphosis at T7–T8 which needed thoracic spine stabilization with pedicle screw instrumentation and fusion. Results This treatment led to complete recovery with no recurrence of symptoms at 8-months' follow-up. Conclusions To date this is the first case of thoracic osteomyelitis secondary to a chronic esophageal perforation to be reported in the literature. A high index of suspicion of this diagnosis is warranted in patients who present with similar clinical and radiological findings to enable prompt diagnosis and avoid the high mortality of esophageal perforation.