A clinical case of multidrug-resistant tuberculosis complicated by esophageal-pulmonary fistula in a palliative patient

Abstract

We present our own observation of the multidrug-resistant tuberculosis course case, complicated by esophageal-pulmonary fistula, in a palliative patient who was treated in the Pulmonary Tuberculosis Department No. 2 of the Zaporizhzhia Regional Phthisio-pulmonology Clinical Treatment and Diagnostic Center. An esophago-pulmonary fistula in the patient with multidrug-resistant tuberculosis was detected in the area of the right upper lobectomy, wich was perfomed 8.5 years ago. The patient was on palliative treatment for almost 6 years before hospital admission when a tubercular esophago-pulmonary fistula was diagnosed. The patient was admitted to the hospital in serious condition, which significantly worsened over the course of a month. A decision was made to perform a computed tomography of the chest cavity (Сhest CT) as the patient's cough and chest pain were associated with liquid food intake. Esophageal-pulmonary fistula was detected on the Chest CT as a linear air defect of the esophageal wall up to 1.5 mm, which conjugates with the cavern in the upper lobe of the right lung. The small size of the esophageal-pulmonary fistula (1.5 mm) indicates the timeliness of its detection. In the presented case, the patient is on palliative treatment. Therefore, in order to prevent the progression of the esophageal-pulmonary fistula, feeding through a nasogastric tube and antibiotic therapy were prescribed. Thus, if a palliative patient with multidrug-resistant tuberculosis has a paroxysmal cough that occurs during or immediately after eating, the use of Chest CT is relevant for the timely diagnosis of eso­phagealpulmonary fistula. If such a fistula is diagnosed, it is necessary to use parenteral feeding and antibiotic therapy.