Abstract
Esophageal involvement in tuberculosis is rare even in highly endemic areas for tuberculosis and is most often secondary to concomitant mediastinal lymph node infection. Endoscopy and imaging are essential for diagnosis. Conservative treatment is possible but the major risk is mediastinitis secondary to an eso-mediastinal fistula.
Highlights
A 19-year-old woman in good general health, originating from the Indian subcontinent, consulted her general physician because of odynophagia, fever and right cervical lymphadenopathy
Clinical assessment was completed by a thoracic CT scan which showed a paradoxical increase in the size of the mediastinal and cervical lymphadenopathy, as well as a pneumomediastinum with a suspicion of an esomediastinal fistula (Figure 2)
Microscopic examination of esophageal biopsies did not show any granulomas, but PCR was positive for Mycobacterium Tuberculosis
Summary
A 19-year-old woman in good general health, originating from the Indian subcontinent, consulted her general physician because of odynophagia, fever and right cervical lymphadenopathy. Node (mediastinal and cervical), pulmonary and hepatic involvement was confirmed and a quadritherapy of Rifampicin, Isoniazid, Pyrazinamide, Ethambutol was initiated. At day 0 + 2 months, the patient reported progressive chest pain and dysphagia. At day 0 + 3 months, an esophagogastroduodenoscopy was performed showing the presence of an esophageal ulcer at 27 cm from the upper dental arch (middle third of the esophagus) of a diameter of approximately 2 cm (Figure 1).
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