Uncommon Etiology for a Rare Post-Transplant Esophago-Lymphatic Fistula

Esophageal tuberculosis (TB) is a rare finding, and esophageal TB fistulas are even rarer. In general, esophageal fistulas are an uncommon finding in everyday practice, but it is frequently seen in advanced endoscopy centers. It can be either congenital or acquired. The acquired type is most commonly a complication of advanced mediastinal malignancy. Other etiologies include trauma, radiation, infections, surgery, aortic aneurysms, or esophageal stents. The most common type of esophageal fistulas is trachea-esophageal. Other types include esophago-aortic, esophago-lymphatic, and esophago-respiratory (other than trachea). The diagnosis is usually made by imaging (barium studies, computed tomography [CT], and magnetic resonance imaging) and endoscopy. Endoscopy is vital in confirming the site of the fistula, assessing the extent, obtaining tissue for histopathologic diagnosis, and, in selected cases, providing therapeutic options. TB esophageal fistulas are diagnosed by endoscopy and biopsy, and the treatment is usually pharmacological.