Unusual presentation of esophageal tuberculosis: a case study

Area of Science:

• Gastroenterology
• Infectious Diseases
• Radiology

Background:

• Esophageal ulcers present diagnostic challenges, mimicking malignancy on imaging.
• Tuberculosis is a rare but significant cause of benign esophageal ulcers.

Observation:

• A 59-year-old woman presented with symptoms suggestive of esophageal malignancy.
• 18F-FDG PET/CT revealed an esophageal lesion and enlarged mediastinal lymph nodes with high FDG uptake.
• Initial suspicion of esophageal cancer was based on PET/CT findings.

Findings:

• Pathological examination revealed inflammation and granulation tissue, excluding malignancy.
• Lymph node biopsy showed caseous necrosis, and microbiological tests confirmed Mycobacterium tuberculosis.
• The final diagnosis was esophageal tuberculosis.

Implications:

• Esophageal tuberculosis can radiologically mimic esophageal cancer, leading to misdiagnosis.
• Endoscopic ultrasonography is crucial for differentiating benign esophageal lesions from malignancy.
• Accurate diagnosis prevents unnecessary invasive treatments and patient harm.