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Esophageal tuberculosis induced dysphagia: a case report
Dylan Olson1, Kevin C Liu2, Anthony P Merza3
1Department of Medicine, Northwestern University, Feinberg School of Medicine, 251 E Huron St, Chicago, IL, 60611, USA. dylan.olson@northwestern.edu.
BMC Gastroenterology
|March 23, 2022
Summary
Extrapulmonary tuberculosis (TB) can present as rare esophageal disease, even in patients without typical risk factors. Early diagnosis and anti-tuberculosis treatment (ATT) led to symptom resolution in this case.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Thoracic Surgery
Background:
- Extrapulmonary tuberculosis (TB) is uncommon in Western populations, with gastrointestinal (GI) TB being a rare manifestation.
- Dysphagia necessitates considering less common etiologies after ruling out typical causes.
Observation:
- A 35-year-old Ethiopian male presented with dysphagia and retrosternal odynophagia.
- Endoscopy revealed a full-thickness esophageal mucosal defect, and CT showed a subcarinal mass inseparable from the esophagus.
- Biopsy of resected mediastinal lymph nodes confirmed Mycobacterium TB complex with granulomatous inflammation.
Findings:
- The patient was diagnosed with esophageal TB due to mediastinal lymphadenopathy invading the esophageal wall.
- Acid-fast bacilli (AFB) were identified in the lymph node culture, confirming active TB infection.
- Despite no known TB exposure or risk factors, the patient responded well to anti-tuberculosis treatment (ATT).
Implications:
- This case highlights the importance of considering esophageal TB in atypical GI presentations, particularly in at-risk populations or those with relevant travel history.
- Prompt diagnosis and treatment of esophageal TB can lead to complete symptom resolution.
- Clinicians should maintain a high index of suspicion for extrapulmonary TB, including GI involvement, in patients with unexplained dysphagia.
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