Primary esophageal tuberculosis mimicking esophageal carcinoma on computed tomography: A case report

Tuberculosis (TB) has a rare extrapulmonary manifestation known as esophageal tuberculosis, accounting for 0.2% of total TB patients. Esophageal TB typically presents with dysphagia, with retrosternal pain or odynophagia, but generalized symptoms such as low-grade fever, decreased appetite, and weight loss are also observed. Esophageal carcinoma and Crohn's disease of the esophagus are important differential diagnoses with similar presentation.

We present a case of a 25-year-old male, who presented with esophageal TB mimicking an esophageal carcinoma. Lab work-up, Mantoux test, and chest X-ray were normal. Barium-swallow examination showed moderate dilatation of distal esophagus with a nodular and irregular mucosa. Computed tomography showed significant thickening of thoracic and distal esophagus with infiltration into the lesser omentum and large, centrally necrotic lymph nodes on gastro-hepatic ligament suggestive of a possible malignancy. Esophagoscopy was performed and a biopsy of mural thickening was performed and sent for histopathological examination. The histopathology report and TB-polymerase chain reaction confirmed the diagnosis of esophageal TB. The patient was started on anti-tuberculous therapy (ATT), and complete resolution of symptoms and disease was achieved in 6 mo.

Esophageal TB is an extremely rare, yet important differential diagnosis in a patient presenting with dysphagia. Esophageal TB can mimic esophageal carcinoma on computed tomography scan. The patient responded well to a complete course of ATT.