Aortoesophageal Fistula Following a Cervical Epidural Steroid Injection: Case Report

Immunosuppression after cervical epidural steroid injection (CESI) is a potential complication. This report discusses the development of an aortoesophageal fistula following a CESI.

Patient is a man in his early 60s with a history of central spinal cord syndrome status post (s/p) anterior cervical discectomy and fusion of C3-C6 and thoracic aortic aneurysm s/p thoracic endovascular aortic repair (TEVAR) who presented with cervical radiculopathy. He underwent a CESI without immediate complications.

Twelve days postop, the patient presented with shortness of breath, fatigue, and change in mental status. He was found to have a pleural abscess and an aortoesophageal fistula from his previous TEVAR stent. He subsequently was admitted to the surgical intensive care unit and received mechanical ventilation, antibiotics, and high-dose vasopressors. Patient was eventually transitioned to comfort care and expired one day after admission.

Systemic steroid absorption from ESIs can lead to complications, such as infection, due to immunosuppression.