We present the case of a 56-year-old male diagnosed with achalasia ten years previously without follow-up. He presented with fever, dysphonia and dyspnea associated with a constitutional syndrome of one month of evolution. Laboratory tests showed leucocytosis of 15,870/ul. The chest radiography confirmed mediastinal widening and a chest computed tomography (CT) showed full esophageal dilation up to 10 cm compressing the trachea and right main bronchus, with tapering at the esophagogastric junction.