Emphysematous Esophagogastritis: a rare and life-threatening presentation of Streptococcus constellatus infection.

Emphysematous esophagogastritis (EEG) is a rare and potentially fatal infection of the upper gastrointestinal tract, marked by gas within the walls of the esophagus and stomach. It is typically associated with gas-forming organisms such as K. pneumoniae, P. aeruginosa, S. aureus, and S. anginosus; however, we report a unique case caused by Streptococcus constellatus, a species known for its aggressive tissue-invasive behavior but rarely implicated in EEG. A previously healthy adult presented with acute epigastric pain, fever, and septic shock. Computed tomography demonstrated diffuse intramural gas and wall thickening of both the esophagus and stomach, consistent with EEG. Blood cultures identified S. constellatus as the causative pathogen. The patient was managed conservatively with intravenous meropenem, proton pump inhibitors, bowel rest, and intensive supportive care. The patient made a complete clinical recovery without requiring surgery in the acute phase. However, a delayed complication, gastric outlet obstruction due to an antral-pyloric stricture, developed during follow-up and necessitated surgical correction. This case underscores the critical importance of early diagnosis, coordinated multidisciplinary care, and prolonged follow-up in managing EEG, and highlights Streptococcus constellatus as a rare but highly invasive pathogen in this life-threatening condition.