Acute phlegmonous esophagitis

Acute phlegmonous esophagitis (APE) is a rare disease caused by bacterial infection of the oesophagus, typically involving the submucosal and muscularis layers. Patients may present with chest pain, dysphagia, odynophagia, dyspnoea, fever, nausea and vomiting, making diagnosis difficult. We present two cases of APE, both young females who presented with dysphagia and odynophagia. The first patient had a history of surgery (left mastoidectomy) which might have functioned as a nidus for infection, whereas the second patient had uncontrolled diabetes. CT findings in both patients revealed diffuse oesophageal thickening, and oesophagogastroduodenoscopy showed erythema and ulcerations. Both patients were managed conservatively using intravenous antibiotics and supportive therapy. APE is associated with a high mortality rate and warrants early diagnosis and treatment. CT is the preferred non-invasive diagnostic modality. Treatment includes systemic antibiotics, nutritional support and timely endoscopic or surgical intervention. Invasive intervention is indicated in patients not responding to medical therapy or in those with complications.