An Interesting Case of Dysphagia in a HIV Patient

Abstract

Oesophageal tuberculosis is a rare disease. Tuberculosis (TB) can cause dysphagia due to oesophageal ulcers, Tracheo-Oesophageal Fistulas (TOFs) and an extrinsic compression which is caused by the mediastinal lymph nodes. A 33-year-old gentleman was admitted to our hospital for the evaluation of fever, dysphagia and cough. His chest X-ray was suggestive of miliary tuberculosis. A CT scan of his chest revealed miliary tuberculosis, mediastinal lymphadenopathy and pneumomediastinum. His sputum AFB (acid-fast bacilli) test was positive. An upper gastrointestinal endoscopy revealed a large ulcer in the oesophagus with a fistulous opening which was suggestive of a tracheo-oesophageal fistula. A biopsy from the ulcer was positive for AFB. The test for HIV-1 was positive. A nasogastric feeding tube was placed and the Anti Tubercular Therapy ( ATT) was started. The main aim of this case report is to sensitize the clinicians about the fact that Tuberculosis can present with dysphagia, especially in HIV patients.

Gastrointestinal CMV Disease and Tuberculosis in an AIDS Patient: Synergistic Interaction between Opportunistic Coinfections

“…The tuberculosis and cytomegalovirus coinfection, although rarely described, has been already reported in other tissues [ 4 , 20 , 21 ]. In the gastrointestinal tract, it was described only once, in a patient with a recent diagnosis of HIV, affecting the distal ileum and ascending colon, presenting shock due to massive intestinal hemorrhage.…”

“…The negative effect that HIV infection plays on the TH1 immune response profile, which is the main effective response against mycobacteria [ 16 ] and essential for maintaining CMV latency [ 4 ], is a determining immunological factor for this type of association [ 16 ]. Additionally, the cytopathic lesion that HIV itself produces in the intestinal epithelium is already a facilitator to new infections in this site [ 22 ].…”

“…Thus, tuberculosis infection also becomes a risk factor for CMV reactivation by accelerating the immunodepression progression by HIV. In addition, tuberculosis also stimulates the production of inflammatory cytokines that aid CMV reactivation [ 4 ].…”

“…The pandemic human immunodeficiency virus (HIV) has dramatically changed the opportunistic infections epidemiology, such as for tuberculosis and cytomegalovirus (CMV) disease. Both have become more prevalent and could be found in association in the same patient, possibly with an unusual natural history [ 1 – 4 ]. The neglect and poor adhesion to antiretroviral therapy (ART), the therapeutic failure, and the lack of access to this therapy made possible that this type of manifestation continued to occur in the same manner it used to occur in the pre-ART era [ 1 – 4 ].…”

Bronchoscopic Decompression of Mediastinal Lymph Node Abscess Using Endobronchial Ultrasound

“…Mediastinal masses and lymphadenopathy can present with dysphagia [1,2]. Tubercular mediastinal lymphadenopathy (TML) can produce dysphagia due to external compression, esophageal ulcerations or tracheoesophageal fistula [3].…”