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Esophageal fistulas associated with mycobacterial infection in patients at risk for AIDS
R de Silva1, P M Stoopack, J P Raufman
1Department of Radiology, State University of New York Health Science Center, Brooklyn.
Abstract:
Although opportunistic infections of the esophagus occur commonly in acquired immunodeficiency syndrome (AIDS), inflammation is generally limited to the mucosal surface. During a 7-month interval, six men at risk for AIDS underwent barium esophagography because of persistent symptoms of esophageal disease. In each case, transmural inflammation of the esophagus was found (esophagomediastinal communication in three cases and esophagobronchial fistulas in three cases). Two patients had an esophagoesophageal fistula, an inflammatory lesion that has not, to the authors' knowledge, been previously described with mycobacterial infection. Mycobacterial infection was documented by means of culture findings in all six patients (Mycobacterium tuberculosis in five, M avium in one). In three cases mycobacteria were either seen in or cultured from esophageal biopsy specimens. The finding of deep esophageal ulceration, intramural dissection, or fistula formation in a patient with AIDS should suggest the diagnosis of esophageal tuberculosis.
Insights
Transmural esophageal inflammation, including fistulas, can occur in patients with acquired immunodeficiency syndrome (AIDS). This presentation suggests esophageal tuberculosis, particularly with deep ulceration or dissection.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Radiology
Background:
- Opportunistic esophageal infections are common in acquired immunodeficiency syndrome (AIDS).
- Typically, esophageal inflammation in AIDS is confined to the mucosal layer.
- Deep esophageal inflammation and fistula formation are rare presentations.
Observation:
- Six men at risk for AIDS presented with persistent esophageal disease symptoms.
- Barium esophagography revealed transmural esophageal inflammation in all cases.
- Esophagomediastinal communication and esophagobronchial fistulas were observed in three patients each.
Findings:
- Mycobacterial infection was confirmed in all six patients (five with Mycobacterium tuberculosis, one with M. avium).
- Esophageal fistulas, including an esophagoesophageal fistula, were identified.
- Mycobacteria were detected in esophageal biopsy specimens in three cases.
Implications:
- Deep esophageal ulceration, intramural dissection, or fistula formation in AIDS patients should raise suspicion for esophageal tuberculosis.
- This study describes previously undocumented esophagoesophageal fistulas associated with mycobacterial infection.
- Early diagnosis and treatment of esophageal tuberculosis are crucial in immunocompromised individuals.