We report a rare case of benign bronchoesophageal fi stula (BEF) of the main left lung lower lobe bronchus associated with granulomatous disease. A 30-year-old male was repeatedly seen over a period of three years at our institution for vague abdominal and respiratory symptoms. He underwent chest radiograph, CT scan of the neck, modifi ed barium swallow study, and multiple endoscopies and laryngoscopies without a defi nitive diagnosis. A diagnosis of bronchoesophageal fi stula was made by single contrast esophagram when a fi stulous tract was demonstrated between the esophagus and left lower lobe bronchus. Chest computed tomography scanning demonstrated the fi stulous tract, but also showed multiple calcifi ed mediastinal lymph nodes adjacent to the site of fi stula, which were thought to be consistent with prior granulomatous disease, likely histoplasmosis which is endemic to our area. The patient was treated surgically, and the fi stula, adhesions, and adherent calcifi ed lymph node were all removed at the time of the procedure. The presence of histoplasmosis could not be confi rmed, but is most likely the cause of this uncommon BEF presentation. In conclusion, this is a rare presentation of a benign, acquired broncho-esophageal fi stula associated with fungal infection.
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