Oesophageal ulceration by tuberculosis: a rare cause of dysphagia

We report on a 58-year old female patient from Afghanistan, who developed a dysphagia within 3 weeks of arrival. On the basis of radiological and endoscopic examination, an oesophageal ulcer was regarded as a malignant tumour, but because of weight loss, fever and night sweats (B symptoms) the question of tuberculosis was also considered by the pathologist. Histological assessment of biopsies produced proof of epithelioid cell granulomas with marginally polygonal giant cells of Langhans-type, as of acid-fast bacilli. In a bacteriological test, three different types of mycobacteria were found. With adequate anti-tuberculosis therapy, the oesophageal ulcer and the mediastinal lymph nodes visible in the computed tomograph soon disappeared, and the patient became free of symptoms. The clinical picture was interpreted as a primary oesophageal tuberculosis with mediastinal lymph nodes as the primary complex. In cases of oesophageal ulcer or dysphagia, tuberculosis should be included in the differential diagnosis, particularly in patients from Asia.