A Rare Cause of Esophageal Dysphagia – Secondary Esophageal Tuberculosis

Abstract

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It continues to be one of the most common causes of death in adults across all countries. It is found to be relatively lower in North America. When aerosol droplets that contain Mycobacterium tuberculosis are inhaled, it can deposit in the respiratory tract, particularly in the patient's lungs. Following this deposition, one of the four outcomes can take place. These include clearance of the organism immediately, primary disease, latent infection, and reactivation disease. Unhindered bacterial growth after primary infection can lead to a hematogenous spread of bacilli to produce disseminated TB. Esophageal involvement causing esophageal TB can be primary or secondary esophageal TB.We present a unique case of secondary esophageal TB with symptoms of dysphagia and odynophagia with primary TB focus on the lung. Computed tomography (CT) of the chest noted diffuse bilateral miliary lung disease. TB QuantiFERON gold and sputum culture were positive for TB. Mycobacterial culture for identification with high-performance liquid chromatography showed isoniazid-resistant TB. The patient was started on antitubercular therapy with rifampin, ethambutol, moxifloxacin, and pyrazinamide for a total of nine months. Esophagogastroduodenoscopy (EGD) reported severe ulcerations of the oropharynx and focal ulceration in the proximal to the mid esophagus. Histopathology revealed active ulcerative and granulomatous esophagitis with mycobacterial organisms. After EGD she was started on a full liquid diet and advanced as tolerated. After discharge, she followed with the Health Department and had three negative sputum cultures after the completion of therapy.

Tuberculosis, A Great Masquerader: A Case Report of Disseminated Multifocal Skeletal TB and Tracheoesophageal Fistulae Mimicking Metastatic Cancer

“…Aerosols containing TB bacilli can be deposited in the respiratory tract, leading to one of four outcomes: immediate eradication of the pathogen, primary illness, latent infection, or reactivation illness. After an initial infection, unchecked bacterial proliferation can cause bacilli to spread haematogenously and cause disseminated/miliary TB [4] . Disseminated TB can involve any organ.…”

“…From the oesophagus to the anus, the entire human gastrointestinal tract may be affected. The ileocecal zone is the most frequent site, accounting for 44–93% of cases [ 4 , 6 ] . The majority of cases of secondary oesophageal TB in the literature are due to the direct extension of mediastinal or pulmonary TB into the oesophagus, making primary oesophageal TB a rare occurrence.…”

“…The primary procedure for obtaining biopsy material is an oesophageal endoscopy. A characteristic caseous lesion, AFB, or molecular methods like Xpert ® MTB/RIF or mycobacterial culture are required for the diagnosis of TB [ 4 , 7 , 8 ] . Tissue biopsy also effectively rules out a metastatic neoplasm.…”

Contemporary Insights Into HIV Esophagitis: Pathogenesis, Therapeutic Strategies, and Prognostic Outcomes

“…Endoscopic biopsy confirms the diagnosis when clusters of bacteria are seen in the specimens combined with necrotic epithelial cells. Antibiotics, which may kill various germs, are part of the treatment plan [ 29 , 30 ]. Viruses and fungi are the most common causes of infectious esophagitis.…”