Mycotic Aneurysm of the Distal Thoracic Aorta after Botulinum Toxin Injection for Esophageal Dysmotility

Abstract Endoscopic injection of botulinum toxin is a common method to treat esophageal dysmotility and achalasia. Patients who undergo this procedure who subsequently present with abdominal or back pain and constitutional symptoms should be evaluated for possible complications of the procedure including occult esophageal perforation, mediastinitis and mycotic aneurysm of the thoracic aorta. The case described herein illustrates the importance of serial imaging in a patient with persistent symptoms following botulinum toxin injection to identify and treat occult aortic inoculation leading to mycotic aneurysm before sepsis and aortic rupture ensue with their attendant morbidity and mortality risks.