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Aortoesophageal Fistula Following a Cervical Epidural Steroid Injection: Case Report
Fangyu Chen1, Praba Boominathan1
1Department of Anesthesia and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
Insights
Systemic steroid absorption from cervical epidural steroid injections (CESI) can cause immunosuppression, leading to serious complications. This case report details a fatal aortoesophageal fistula developing after a CESI.
Area of Science:
- Anesthesiology
- Interventional Pain Management
- Gastroenterology
Background:
- Cervical epidural steroid injections (CESI) carry a risk of immunosuppression.
- This report details a rare complication following CESI.
Background:
Immunosuppression after cervical epidural steroid injection (CESI) is a potential complication. This report discusses the development of an aortoesophageal fistula following a CESI.
Case Report:
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.
Abstract:
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.
Conclusions:
Systemic steroid absorption from ESIs can lead to complications, such as infection, due to immunosuppression.
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