Missed diagnosis and treatment of esophageal foreign bodies (FBs) carry a risk of severe, life-threatening complications. This case report details the diagnostic and therapeutic management of a 58-year-old woman with a minimally invasive penetrating FB (MIPFB) following fish bone ingestion, who presented with odynophagia. Initial clinical evaluation and electronic nasopharyngolaryngoscopy were unremarkable. A cervical computed tomography scan on day 6 post-ingestion revealed a penetrating FB at the C6 vertebral level. Initial flexible esophagoscopy and a subsequent surgical exploration failed to localize the object. The FB, an approximately 2.5-cm-long fish bone embedded in the right posterior wall of the esophageal inlet, was ultimately and successfully retrieved via a repeated, meticulous endoscopic procedure employing targeted mucosal manipulation. This case highlights that MIPFB cases are prone to diagnostic delay and emphasizes that repeated, careful endoscopy is a superior and less invasive therapeutic strategy compared to surgical exploration in such complex scenarios.

Amyloidosis is a rare and heterogeneous group of disorders characterized by extracellular deposition of misfolded proteins, which may present as either localized or systemic disease. In the head and neck region, the presentation of amyloidosis is uncommon and may clinically mimic neoplastic processes. We report the case of a 58-year-old man with a five-year history of progressive oropharyngeal symptoms, initially perceived as a foreign body sensation and intermittent odynophagia, later evolving to dysphagia to solids. Physical examination revealed marked asymmetry of the palatine tonsils due to a mass originating from the left tonsillar fossa. Imaging studies confirmed a well-defined lesion without clear signs of invasion. Given the progressive symptoms and the size of the lesion, surgical excision was performed. Histopathological analysis demonstrated amyloid deposition confirmed by Congo red staining, with immunophenotypic features consistent with a lambda-restricted plasma cell neoplasm. The patient was referred for further hematologic evaluation to exclude systemic disease, but declined additional workup. This case illustrates how localized amyloidosis may closely resemble neoplastic disease both clinically and radiologically, and highlights the central role of histopathological evaluation. It also emphasizes the importance of considering systemic involvement even in apparently localized presentations.

Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein and hematogenous dissemination of septic emboli. Although classically associated with oropharyngeal infections, atypical presentations from odontogenic sources are increasingly recognized and may complicate early diagnosis. We report the case of a 29-year-old male patient who developed Lemierre syndrome following lower third molar extraction. He presented with right cervical swelling, dysphonia, odynophagia, and cough. Laboratory findings showed leukocytosis with neutrophilia. Imaging studies revealed a deep cervical collection consistent with Ludwig's angina, extensive thrombosis of the right internal jugular vein with extension to the jugular bulb, sigmoid sinus, and subclavian vein, and multiple bilateral pulmonary lesions suggestive of septic emboli. The patient underwent surgical drainage and received broad-spectrum antibiotic therapy along with anticoagulation due to the extent of thrombosis. Microbiological cultures were negative, likely influenced by prior antibiotic exposure and the inherent difficulty in isolating anaerobic pathogens such as Fusobacterium species. Despite significant radiological involvement, clinical evolution was favorable, without hemodynamic instability or respiratory compromise. Follow-up demonstrated a reduction of pulmonary lesions and eventual resolution of thrombosis. This case highlights an uncommon odontogenic origin with unusually extensive venous propagation, including intracranial extension, in the setting of a relatively benign systemic course. It underscores the importance of considering Lemierre syndrome in deep cervicofacial infections after dental procedures, even in the absence of a preceding pharyngeal infection, and reinforces the need for early imaging and multidisciplinary management to enable timely diagnosis and appropriate treatment.

During routine dissection of a medical cadaver, an aberrant right subclavian artery (ARSA) was identified originating from the aortic arch. An ARSA, present in 0.2-2.5% of the population and often asymptomatic, increases the risk of surgical nerve injury during head, neck, and thoracic surgeries. ARSAs can also impinge on the esophagus and cause dysphagia or odynophagia, impinge on the trachea and cause dyspnea, or be impinged by the esophagus and/or trachea, limiting blood supply to the upper extremity. Most often, ARSAs follow a retroesophageal course, as in this case. In addition to the ARSA, the vertebral arteries were also variant and branched directly off the common carotid arteries, as opposed to the subclavian arteries, and the right recurrent laryngeal nerve was nonrecurrent. This case describes a donor with three anatomical anomalies to highlight the clinical relevance of recognizing ARSA and related variants and how to identify signs and symptoms of a symptomatic ARSA.

Fish bone impaction in the oropharynx is a common cause of foreign body sensation and odynophagia. While computed tomography (CT) has the highest sensitivity and specificity among radiologic imaging modalities in the detection of fish bone foreign bodies, false negatives still occur. This case demonstrates the critical importance of clinical judgement and further evaluation when foreign body symptoms persist despite negative imaging findings. A 67-year-old woman presented to the emergency department (ED) twice within 24 hours with persistent odynophagia and foreign body sensation after eating catfish. CT imaging demonstrated no foreign body on both occasions. Oral examination and flexible endoscopy under anesthesia were subsequently performed due to persistent symptoms. Inspection of the oral cavity revealed a 4-cm fish bone embedded in the left pyriform sinus. The bone was extracted without difficulty. The patient recovered without complication and had immediate resolution of her symptoms. This case highlights that fish bones can be radiologically occult and that persistent symptoms of odynophagia and foreign body sensation following fish ingestion warrant further evaluation regardless of negative imaging findings. Clinical judgement should supersede imaging results in suspected foreign body cases, as delayed removal increases complication risk (esophageal laceration and perforation, ulceration, mediastinitis, as well as abscess formation). Emergency physicians and otolaryngologists should maintain a high index of suspicion when clinical presentation strongly suggests fish bone foreign body impaction despite negative imaging findings.

Shewanella species are motile, oxidase-positive, non-fermenting Gram-negative bacilli widely distributed in marine and aquatic environments. Although primarily environmental organisms, Shewanella spp. are rare human pathogens, most often associated with skin and soft tissue infections. Involvement of the head and neck region is exceptional. We report the case of a 28-year-old immunocompetent male with no history of seawater exposure who presented with a one-week history of odynophagia, fever, trismus, and dysphagia. Clinical examination revealed a unilateral peritonsillar abscess. Needle aspiration yielded hemopurulent material. Direct microscopy showed numerous neutrophils and Gram-negative bacilli. Culture on standard media grew monomorphic, non-lactose-fermenting colonies. Identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (Bruker Daltonics, Bremen, Germany) confirmed Shewanella putrefaciens with a high-confidence score. Antimicrobial susceptibility testing demonstrated resistance to penicillins, β-lactam/β-lactamase inhibitor combinations, and cephalosporins, with preserved susceptibility to fluoroquinolones, aminoglycosides, and carbapenems. Empiric therapy with amoxicillin-clavulanate was ineffective, whereas targeted treatment with levofloxacin resulted in complete clinical recovery. This case highlights S. putrefaciens as an uncommon but clinically relevant cause of refractory peritonsillar abscess and underscores the importance of accurate microbiological identification, particularly in patients not responding to standard empiric therapy.

Intramural esophageal hematoma is an uncommon condition that may mimic esophageal abscess on initial imaging. We report a 43-year-old man who presented with three days of odynophagia and dysphagia, aggravated by swallowing hard food, followed by abrupt severe epigastric pain. Initial CT showed a long upper esophageal intramural fluid-density lesion with wall thickening, raising concern for esophageal abscess. He had leukocytosis, and fever with elevated C-reactive protein developed during hospitalization; antibiotics were therefore administered because abscess or secondary infection could not initially be excluded. Repeat CT approximately 14 hours later showed interval intraluminal decompression without rim enhancement, intralesional gas, mediastinal fat stranding, extraluminal air, or contrast leakage. Upper endoscopy showed a dark-red submucosal bulge with mucosal rupture. The patient improved with fasting, parenteral nutritional support, acid suppression, antibiotics, and observation, without endoscopic drainage or surgery. Follow-up endoscopy at six weeks showed healing, and no recurrence occurred during six months of follow-up.

Within the aerodigestive tract, syphilis presents with varied signs and symptoms, some of which may mimic malignancy or other disease processes. We present the case of a 29-year-old man with otalgia and odynophagia who was found on physical examination and office laryngoscopy to have a 4-cm ulcerative mass of the tongue base and cervical lymphadenopathy. While planning for tissue diagnosis, the patient's serologies revealed positive treponemal antibody testing and elevated rapid plasma reagin (RPR) titers, confirming syphilitic infection, likely representing secondary syphilis. While awaiting operative biopsy, the patient received intramuscular penicillin with complete resolution of the mass and symptoms, and ultimately operative intervention was deferred. While planning for biopsy of suspicious head and neck lesions, clinicians should consider infectious disease workups in patients with risk factors.

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disorder characterized by the formation of autoantibodies and immune complex deposition, leading to inflammation and damage across various organs. Although the disease commonly involves the skin, joints, kidneys, hematological system, and central nervous system, involvement of the larynx is distinctly rare and often remains undiagnosed. Laryngeal manifestations may vary from mild mucosal edema and dysphonia to severe ulceration, hemorrhage, cricoarytenoid arthritis, and potentially life-threatening airway obstruction. Due to its rarity and nonspecific presentation, laryngeal involvement in SLE may mimic infective, neoplastic, or other inflammatory conditions, posing a diagnostic challenge for otolaryngologists. We report a case of a 54-year-old female patient who presented with acute onset of odynophagia and a change in voice, which on Hopkins rod evaluation revealed marked supraglottic edema with hemorrhagic bullae and ulcerative lesions. Hematological findings revealed severe anemia and leukopenia, and immunological tests confirmed SLE. She was treated with systemic corticosteroids and supportive therapy, leading to significant clinical and endoscopic improvement. This case highlights the importance of considering autoimmune etiologies such as SLE in patients presenting with unexplained laryngeal edema and ulceration, as early diagnosis and timely management are crucial to prevent airway compromise and associated morbidity.

Acute epiglottitis in adults is an uncommon but potentially life-threatening condition that can rapidly progress to airway compromise. Epiglottic abscess represents a rare and severe complication associated with increased morbidity and diagnostic challenges. We report a case of a 36-year-old male admitted to the emergency department in Belgium with progressive odynophagia, dysphonia, and hypersalivation despite prior oral antibiotic therapy. Laboratory investigations revealed a marked inflammatory response, including leukocytosis and elevated C-reactive protein. Contrast-enhanced computed tomography (CT) of the neck demonstrated a 30 mm epiglottic abscess extending toward the right tonsillar region, with associated mass effect on the supraglottic airway. The patient was admitted to the intensive care unit for close airway monitoring and was managed conservatively with intravenous antibiotics, corticosteroids, and supportive care. Despite the size of the abscess, no surgical intervention was required. The patient showed rapid clinical improvement, with complete resolution of symptoms and no airway compromise. This case highlights the importance of early imaging and vigilant airway assessment in adult epiglottitis. It also supports the role of conservative management in carefully selected, clinically stable patients with epiglottic abscess.

Herpes simplex virus esophagitis (HE) is a commonly observed disease in immunocompromised individuals, but is rare in immunocompetent individuals and often misdiagnosed due to overlapping features with other causes of esophagitis. Delay in diagnosis and appropriate treatment can lead to severe complications such as esophageal ulceration, resulting in bleeding, perforation, fistulas, food impaction, and strictures. We report a rare case of recurrent HE in an immunocompetent male initially misdiagnosed as Candida esophagitis. This case underscores the importance of considering HSV in the differential diagnosis of esophageal ulcerations, highlights the potential for recurrence in immunocompetent hosts, and emphasizes the need for accurate diagnosis, timely antiviral therapy, and patient education to prevent complications.

Esophageal ulceration is an important cause of odynophagia and chest pain in immunocompromised patients and is most commonly attributed to infectious etiologies such as cytomegalovirus, herpes simplex virus, and fungal infection. We report a 39-year-old woman with polymyositis receiving chronic methotrexate and corticosteroid therapy who presented with acute odynophagia. Endoscopy revealed a large cratered ulcer in the upper third of the esophagus. Biopsy demonstrated acute inflammatory changes without evidence of infection or malignancy. The patient improved with proton pump inhibitor therapy. This case highlights that noninfectious inflammatory ulceration should be considered after exclusion of infectious causes.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus with substantial clinical manifestations including dysphagia, odynophagia, food impaction and failure to thrive in children. New evidence is emerging regarding phenotypic and symptom variations in diverse EoE populations. EoE pathogenesis involves impaired epithelial barrier function, antigen-driven Type 2 inflammation, and eosinophilic infiltration, yet eosinophil and mast cell depletion does not improve patient symptoms. Recent research has unveiled new potential mechanisms of epithelial dysfunction, including the role of epithelial alarmins in inducing downstream inflammatory cascades. New clinical scoring tools are emerging to improve diagnosis and monitor disease severity. Therapeutic approaches for EoE are rapidly evolving with a wider range of therapies becoming available. Dietary elimination, topical corticosteroids, proton pump inhibitors (PPIs), and anti-type 2 biological agents aim to provide histologic and symptomatic relief. Overall, this review aims to present recent advances in the epidemiology, pathophysiology, diagnosis, and treatment of EoE, while also extending this information to the broader field of eosinophilic gastrointestinal diseases (EGIDs).