Esophageal-atrial fistula

Area of Science:

• Gastroenterology and Cardiology
• Connective Tissue Diseases

Background:

• Scleroderma, a systemic autoimmune disease, can affect multiple organs, including the esophagus.
• Barrett's esophagus is a known complication of chronic acid reflux, often associated with scleroderma-related esophagitis.

Observation:

• An unusual case of an esophageal-atrial fistula is presented in a patient with the CREST (calcinosis, Raynaud's phenomenon, esophagitis, sclerodactyly, telangiectasia) variant of scleroderma.
• A perforated ulcer in the Barrett's esophagus led to the fistula, connecting the esophagus to the left atrium.

Findings:

• The fistula resulted in systemic embolization and a subsequent cerebral abscess, a severe neurological complication.
• Review of literature reveals a pattern of chronic esophageal pathology, gastrointestinal bleeding, and neurological signs in similar cases.

Implications:

• This case underscores the potential for rare but life-threatening complications arising from esophageal pathology in systemic sclerosis.
• The lack of antemortem diagnosis in reported cases suggests a need for increased awareness and diagnostic consideration of esophageal-atrial fistula in at-risk patients.