Bronchoesophageal fistula due to Mycobacterium tuberculosis and cytomegalovirus in a patient with AIDS.

Abstract

Porter and colleagues reported three cases of tuberculous bronchoesophageal fistulae in HIV-infected patients [1]. We recently cared for another such patient with concomitant cytomegalovirus (CMV) infection. A 40-year-old male was admitted for evaluation of fever, weight loss, and nonproductive cough, which occurred especially while he was drinking liquids. He had been known to be infected with HIV for 5 years but did not have a history of prior opportunistic infections. On physical examination he had fever (temperature to 103?F) but was in no distress. Examination of the lungs did not reveal any abnormalities. The CD4+ cell count was 44/mm3. Radiographs of the chest disclosed diffuse interstitial infiltrates and mediastinal fullness. A CT scan revealed extensive mediastinal infiltration, lymphadenopathy, and pneumomediastinum. A barium swallow demonstrated two discrete areas of extravasation; one area was 4-5 cm above the carina, and the second extended from the subcarinal area, which communicated with the right mainstem bronchus. Bronchoscopy demonstrated only mild endobronchial inflammation. Examination of biopsy specimens from the carinal area adjacent to the fistulous tract disclosed chronic inflammatory changes and eosinophilic inclusions consistent with CMV infection. Special stains were negative for acid-fast bacilli (AFB), fungi,