A 65-year-old female was diagnosed with FIGO stage IVB high-grade serous ovarian carcinoma (radiologic pathological cardiophrenic adenopathies) in February 2019. She received four cycles of carboplatin AUC6 and paclitaxel 175 mg/m2 chemotherapy as neoadjuvant treatment. The patient achieved clinical and radiological response including remission of cardiophrenic involvement. The Multidisciplinary Committee recommended interval debulking surgery in August 2019. It consisted of total hysterectomy, double adnexectomy, omentectomy, appendicectomy, and wide peritonectomies; lymphadenectomy was not required because of the absence of macroscopic lymph nodes. Surgery was optimal without macroscopic residual disease. Genetic counseling revealed a germinal pathogenic mutation in BRCA1 gene (c.3770-3771delAG). After surgery, the patient completed three cycles of carboplatin and paclitaxel, finishing the last of the cycles in November 2019. Olaparib (300 mg/m2 bid) was initiated as a maintenance therapy. Owing to recurrent grade 3 anemia despite dose reductions, treatment was stopped in December 2020. The first recurrence was detected in January 2021, when platinum remained still an option. It was located in the peritoneum and mediastinal lymph nodes and was therefore considered unresectable. The patient was enrolled in a clinical trial for second-line treatment with carboplatin AUC5-liposomal pegylated doxorubicin 30 mg/m2 +/− antiPDL1, achieving a partial response after three cycles in May 2021, which was maintained after five cycles. In October 2021, she initiated maintenance therapy with niraparib 200 mg daily +/− antiPDL1 until progression of adenopathies in the mediastinum was detected in March 2022. Third-line treatment consisted of weekly paclitaxel (80 mg/m2) plus biweekly bevacizumab (15 mg/kg) with a partial response in the first CT scan exam. In October 2022, the patient started with non-specific symptoms of epigastralgia and esophagitis initially treated with proton-pump inhibitors as no progression in the mediastinum was detected in the computerized tomography (CT) scan and first esophagogastroscopy reported no lesions in the mucosa. In December 2022, clinical symptoms progressed to dysphagia and aphonia, and the Ca 125 levels increased dramatically from 300 UI/mL to 1,500 UI/mL in 2 weeks, and a CT scan showed esophageal thickening, shown in. The patient was admitted to the hospital due to an infectious respiratory condition in January 2023, and as aphonia and mild dysphagia persisted, a second examination with endoscopic ultrasonography (EUS) was performed. The results showed diffuse thickening of the esophageal wall with preserved layered echostructure, at the expense of the more superficial layers (mucosa and submucosa) with whitish/yellowish plaques compatible with extensive esophageal candidiasis. Biopsies were performed, reporting severe candidiasis; no malignant cells were identified at that moment. Fluconazole (400 mg/day) was administered for 21 days, and the oncological treatment was stopped because of active infectious disease. After completing treatment with antifungals, the patient continued with progressive dysphagia until it became complete for solids and partially for liquids. The patient was admitted to the hospital again in early February 2023 because disease progression was suspected. The patient presented with clinical signs of deterioration and malnutrition. The differential diagnosis at that time was progressive disease with esophageal infiltration versus fluconazole-resistant candidiasis; however, a CT scan showed increasing esophageal thickening and Ca 125 levels continued to increase at 4,500 UI/mL. We considered to repeat esophagogastroscopy, which revealed a fibrinated ulcer measuring 15 mm with an ovoid morphology compatible with fistulation to the mediastinum, as shown in. A nasogastric feeding tube was then inserted. The patient’s clinical evolution worsened with signs of sepsis due to mediastinitis with progressive respiratory failure until the patient died despite antibiotic and supportive treatment. Pathological reports have described infiltration by high-grade serous carcinoma consistent with disease progression, as shown in. The CARE Checklist has been completed by the authors for this case report, attached as online supplementary material (for all online suppl. material, see ).