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Asymptomatic spinal tuberculosis presenting as esophageal stricture
M S Bhatnagar1, S A Nanivadekar, P Sawant
1Department of Gastroenterology, LTMG Hospital & LTM Medical College, Bombay.
Summary
Esophageal tuberculosis, a rare condition, can cause esophageal strictures. This case highlights the importance of considering tuberculosis in dysphagia diagnosis, even with non-specific biopsies, as the patient responded well to anti-tubercular therapy.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pulmonology
Background:
- Esophageal tuberculosis (ETB) is an uncommon manifestation of Mycobacterium tuberculosis infection.
- It typically arises from direct extension from adjacent infected structures, such as the trachea or lymph nodes.
- Accurate diagnosis can be challenging due to nonspecific symptoms and endoscopic findings.
Observation:
- A patient presented with dysphagia, indicating difficulty swallowing.
- Esophageal stricture was identified as the cause of dysphagia.
- Initial endoscopic biopsies were inconclusive for malignancy or tuberculosis.
- Thoracic computed tomography (CT) revealed involvement of the fourth thoracic vertebra and paratracheal lymphadenopathy.
Findings:
- The CT findings suggested a contiguous spread of infection, consistent with tuberculosis.
- Despite non-diagnostic initial biopsies, the clinical presentation and imaging were suggestive of ETB.
- The patient showed significant improvement after initiating anti-tubercular therapy.
Implications:
- This case underscores the importance of considering ETB in the differential diagnosis of esophageal strictures, particularly in endemic areas.
- Advanced imaging like CT can be crucial for identifying underlying tuberculous involvement when biopsies are non-diagnostic.
- Prompt diagnosis and treatment of ETB can lead to favorable outcomes and prevent complications.