Esophageal Tuberculosis Mimicking Malignancy in an Immunocompetent Patient: A Case Report

Esophageal tuberculosis is a rare manifestation of extrapulmonary tuberculosis, often misdiagnosed due to its nonspecific clinical features and resemblance to malignancy. We report the case of a 65-year-old immunocompetent woman with no prior medical history who presented with an 8-kg weight loss over three months and progressive dysphagia. Laboratory investigations revealed leukocytosis without other abnormalities, and HIV serology was negative. Upper gastrointestinal endoscopy showed an ulcerated and exophytic lesion in the distal third of the esophagus. Histopathological examination revealed granulomatous inflammation with caseating necrosis, and PCR confirmed Mycobacterium tuberculosis. The patient was treated with standard anti-tuberculosis therapy, an initial two-month quadruple drug regimen followed by a four-month continuation phase with dual therapy. Marked clinical improvement was observed after one month of treatment. This case underscores the importance of considering tuberculosis in the differential diagnosis of esophageal lesions, even in immunocompetent patients, and highlights the critical role of systematic biopsy of any lesion during endoscopy, including those with typical appearances such as ulcerations.