Esophagomediastinal Fistula Secondary to Multidrug-resistant Tuberculous Mediastinal Lymphadenitis

Ko, Yousang; Lee, Ho‐Young; Lee, Youngseok; Kim, Mi‐Yeong; Lee, Young-Min; Kang, Mi Seon; Shin, Jeong Hwan; Choi, Seok Jin; Lee, Yang-Haeng; Lee, Hyun-Kyung

doi:10.2169/internalmedicine.53.2145

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…More recently, in 2014, a case of MDR-TB mediastinal lymphadenitis with esophagomediastinal fistula was reported [15]. This case was similar to our own in several ways: both cases involved MDR-TB-induced mediastinal lymphadenitis and an esophagomediastinal fistula.…”

Section: Discussionsupporting

confidence: 83%

Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor

Kim

Lee

et al. 2016

Clin Endosc

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Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.

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Section: Discussionsupporting

confidence: 83%

Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor

Kim

Lee

et al. 2016

Clin Endosc

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“…The role of surgery for TB-related OPF remains controversial. All OPF secondary to TB did not require surgical intervention except in one paediatric patient [ 11 ]. Surgery is highly invasive, reserved for recurrent oesophageal fistulas or failure of medical management but the evidence is limited only to case reports.…”

Section: Discussionmentioning

confidence: 99%

The rare case of oesophago-pericardial fistula secondary to pulmonary tuberculosis

Sidhu

Seyfi

Lau

et al. 2022

Journal of Surgical Case Reports

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We report the case of a healthy 35-year-old male with two rare pathologies: pneumopericardium and oesophago-pericardial fistula (OPF) secondary to tuberculosis. Purulent pericarditis and cardiac tamponade are known complications with potential for significant morbidity and mortality. Unfortunately, the symptoms of OPF are non-specific often delaying diagnosis. There is no gold standard for treatment or determinant of when nonsurgical versus surgical approach should be considered. Anti-tuberculous therapy alone is often adequate however an oesophageal stent was utilized in this case to rapidly gain control of the fistula and prevent ongoing contamination from mediastinitis.

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“…Esophageal tuberculosis rarely occurs, mostly secondary to a nearby necrotic mediastinal lymph node tuberculosis. Therefore, for such cases, esophageal tuberculosis should be considered [6,7]. The radiological findings of esophageal tuberculosis should be differentiated from other esophageal lesions, including esophageal leiomyoma, esophageal cancer, and esophageal ulceration.…”

Section: The Opportunistic Infectionsmentioning

confidence: 99%

Diagnostic imaging of gastrointestinal lesions complicating AIDS

Zhang

Zhao

Chen

et al. 2015

Radiology of Infectious Diseases

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Objective: To investigate the findings about gastrointestinal lesions in patients with HIV/AIDS by diagnostic imaging.Methods: The findings about gastrointestinal lesions by diagnostic imaging in 11 patients with HIV/AIDS were retrospectively analyzed. Plain chest radiography was performed for all the 11 cases, but chest CT scanning for 4 cases, abdominal CT scanning for 9 cases, pelvic CT scanning for 2 cases, pelvic MR imaging for 1 case, and gastrointestinal endoscopy for 9 cases. Results: Gastrointestinal perforation was shown in 3 cases, including 2 cases of esophageal perforation and 1 case of gastric perforation. Intestinal tuberculosis was diagnosed in 2 cases, cytomegalovirus enteritis in 1 case, lymphoma in 4 cases, and gastric adenocarcinoma in 1 case. Esophageal perforation was shown together with mediastinal esophageal fistula, mediastinal lymph nodes tuberculosis and pulmonary tuberculosis. Gastric perforation was shown with gastric fistula, left lobe hepatic abscess and hepatogastric space abscess. Intestinal tuberculosis was shown with thickened ileocecal wall, while cytomegalovirus colitis was indicated by central thickening of rectum wall and the end-piece of sigmoid colon. Lymphoma was indicated by tumor-like thickening of gastrointestinal wall, luminal stenosis or dilatation, with accompanying ulceration and enlarged peripheral lymph nodes. Gastric adenocarcinoma was demonstrated with thickening and stiffness of gastric wall, with significant enhancement by contrast imaging/scanning. Conclusion: Gastrointestinal lesions in patients with HIV/AIDS may indicate a variety of opportunistic infections and malignancies, and radiological modalities contribute to the diagnosis of these lesions.

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Esophagomediastinal Fistula Secondary to Multidrug-resistant Tuberculous Mediastinal Lymphadenitis

Cited by 11 publications

References 23 publications

Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor

Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor

The rare case of oesophago-pericardial fistula secondary to pulmonary tuberculosis

Diagnostic imaging of gastrointestinal lesions complicating AIDS

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