Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

28 August 2018 : Case report  Taiwan

Aortoesophageal Fistula Causing Massive Gastrointestinal Bleeding and Death in a Patient with Dermatomyositis: A Case Report

Challenging differential diagnosis, Rare disease

Teressa Reanne Ju1AEF, Chi Chan Lee2CDF, Yu-Chao Lin1ACDF*

DOI: 10.12659/AJCR.910283

Am J Case Rep 2018; 19:1025-1029


BACKGROUND: Aortoesophageal fistula is a rare etiology of serious gastrointestinal bleeding. Most aortoesophageal fistulas resulted from thoracic aortic aneurysms, foreign bodies, or esophageal malignancy. To our knowledge, spontaneous aortoesophageal fistula due to dermatomyositis and high dose steroid therapy has not been reported.

CASE REPORT: A 46-year-old Asian female with a history of dermatomyositis and duodenal ulcers presented with black stool for one day. She was initially admitted for dermatomyositis flare-up and received high dose steroid therapy. Four weeks after discharge, she experienced gastrointestinal bleeding from multiple duodenal ulcers. Due to a continuous fall in hemoglobin level, she received angiography and embolization to the gastroduodenal artery. After the procedure, the patient developed another episode of dermatomyositis flare-up and required endotracheal intubation. During ventilator weaning, she developed recurrent gastrointestinal bleeding. Repeated esophagogastroduodenoscopy showed one esophageal ulcer with active bleeding. Epinephrine hemostasis therapy was performed but with poor therapeutic response. Angiography showed no visible extravasation. Chest computed tomography with intravenous contrast revealed contrast extravasation in esophageal lumen with blood clots consistent with an aortoesophageal fistula. Despite our attempt to arrange an emergent endovascular stent, the patient went into cardiac arrest from circulatory collapse.

CONCLUSIONS: Dermatomyositis leads to esophageal structural abnormalities through various mechanisms. Aortoesophageal fistula is a life-threatening etiology of gastrointestinal bleeding and should be suspected if bleeding from an esophageal ulcer responds poorly to hemostatic treatment. Abdomen computed tomography with intravenous contrast is the preferred image modality for diagnosing aortoesophageal fistula. Thoracic endovascular aortic repair is a reasonable procedure to stop bleeding in patients with unstable hemodynamic profiles.

Keywords: Aorta, Thoracic, dermatomyositis, Esophageal Fistula, Gastrointestinal Diseases

Add Comment 0 Comments

1040 14

In Press

01 Dec 2023 : Case report  Brazil

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Am J Case Rep In Press; DOI:  

01 Dec 2023 : Case report  Belgium

Innovative Approach to Difficult Airway Management: Utilizing the Cook® Airway Exchange Catheter for Double...

Am J Case Rep In Press; DOI:  

01 Dec 2023 : Case report  Saudi Arabia

Successful Conservative Therapy for Infected Penile Implants: A Case Series

Am J Case Rep In Press; DOI:  

30 Nov 2023 : Case report  Puerto Rico

Scuba Diving-Induced Inner-Ear Pathology: Imaging Findings of Superior Semicircular Canal and Tegmen Tympan...

Am J Case Rep In Press; DOI:  

Most Viewed Current Articles

06 Dec 2021 : Case report  Brazil

Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases

DOI :10.12659/AJCR.934406

Am J Case Rep 2021; 22:e934406

07 Dec 2021 : Case report  USA

Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...

DOI :10.12659/AJCR.934347

Am J Case Rep 2021; 22:e934347

19 Jul 2022 : Case report  Saudi Arabia

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

DOI :10.12659/AJCR.936128

Am J Case Rep 2022; 23:e936128

13 Jul 2022 : Case report  USA

Whistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound

DOI :10.12659/AJCR.936441

Am J Case Rep 2022; 23:e936441

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923