Boerhaave’s syndrome complicated by pneumorrhachis and chemical meningitis

Boerhaave's syndrome is a life-threatening condition characterised by oesophageal perforation. This report presents a case of Boerhaave's syndrome complicated by pneumorrhachis (air in the spinal canal) and chemical meningitis. A 26-year-old male developed meningism and an agitated delirium following oesophageal rupture, with imaging confirming pneumorrhachis and cerebrospinal fluid analysis consistent with chemical meningitis. Despite a prolonged Intensive Care Unit stay complicated by encephalopathy and severe agitation, the patient made a full neurological recovery with supportive care. This case illustrates a unique pathophysiological progression and underscores the importance of early recognition, exclusion of bacterial meningitis, appropriate prognostication and multidisciplinary management of pneumorrhachis complicating Boerhaave's syndrome.