Reversible St-Segment Elevation in the Setting of Acute Esophagitis Caused by Caustic Drain Cleaner Ingestion

Caustic ingestion remains a significant clinical challenge, often resulting in severe transmural oesophageal injury. Given the immediate anatomical proximity of the oesophagus to the left atrium and ventricle, severe inflammation can extend to adjacent cardiac structures, potentially mimicking acute coronary syndrome.

A 22-year-old male presented following the intentional ingestion of sodium hydroxide drain cleaner. Initial endoscopy identified injury that rapidly progressed from Zargar grade 1 to 3B. Simultaneously, the patient developed acute ST-segment elevation and a marked troponin elevation of 85.15 ng/ml. Despite these findings, echocardiography confirmed normal ventricular function and no pericardial effusion. Managed conservatively with multidisciplinary support, the patient's electrocardiographic abnormalities showed progressive normalization that correlated with clinical improvement of the oesophageal injury. Unfortunately, the patient succumbed to pulmonary and vascular complications 28 days later.

Severe transmural esophagitis can produce dramatic, reversible cardiac manifestations through direct inflammatory extension. This case highlights the importance of recognizing non-cardiac causes of ST-segment elevation to avoid unnecessary, high-risk cardiac interventions in critically ill patients. Serial electrocardiograms may serve as a non-invasive marker reflecting the severity and progression of underlying oesophageal necrosis.

Mimicry of acute coronary syndrome This case highlights that transmural oesophageal inflammation from alkaline ingestion can cause marked ST-segment elevation and significant troponin elevation (85.15 ng/ml) due to direct inflammatory extension to the adjacent myocardium, mimicking a myocardial infarction.Anatomical clinical correlation Understanding the posterior relation of the oesophagus to the left atrium and ventricle allows internists to recognize "oesophageal-cardiac" phenomena, potentially preventing high-risk, unnecessary cardiac catheterizations in critically ill patients with coagulopathy.Prognostic monitoring Serial electrocardiograms can serve as a non-invasive marker of transmural disease progression. In this case, the worsening of Zargar grades directly paralleled the evolution of electrocardiographic abnormalities.