Tuberculosis presenting as dysphagia: Clinical, endoscopic, radiological and endosonographic features

Abstract

Objective:Dysphagia as a presenting manifestation of tuberculosis is rare and there is paucity of data on the clinical, endoscopic and endosonographic features of these patients. We present our data related to the features over last four years.Methods:We analyzed retrospectively the clinical, endoscopic, radiological, endosonographic and cytological findings in 14 patients (male: 10; mean age: 37.7 ± 10.4 years) with dysphagia due to tuberculosis presenting to us over last 4 years.Results:Nine patients (64.3%) had Grade 1 dysphagia, 4 (28.6%) patients had Grade 2 and 1 patient (7.1%) had Grade 3. Mid esophagus was the commonest site of involvement. Endoscopic findings were extrinsic bulge (50%), linear ulcers (28.6%) and pol-ypoidal ulcerated lesion (7.1%). Endoscopic biopsies were inconclusive. Endoscopic ultrasound (EUS) demonstrated mediastinal lymph nodes being responsible for endoscopic bulge and their infiltration into esophageal wall leading on to ulcers. EUS-guided fine needle aspiration from these nodes established diagnosis in all patients.Conclusion:Dysphagia in tuberculosis is most commonly caused by compression by the surrounding mediastinal lymph nodes. EUS is a useful investigation for assessment of these patients.

Esophageal tuberculosis: Uncommon of common

“…In total, all of our patients had secondary involvement of esophagus. Most other reports also demonstrated that secondary TB is the most common type, with the most common mode of esophageal involvement secondary to mediastinal lymph nodal disease, and only one case series had predominant primary involvement of esophagus . In our study, the most common site of involvement was the mid‐esophagus, which correlated well with adjacent mediastinal lymphadenopathy.…”

“…In comparison, the other two recent publications also reported median age of 31 and 37 years . Dysphagia is the most common symptom as mentioned in all publications, but uncommon presentation like hematemesis has also been reported in a few, and, in our series as well . Four of our patients also had fistula‐related symptoms.…”

“…Constitutional symptoms were present in 48–89% patients. Our series had a slight female predominance in contrast to the other two studies from India . Pulmonary lesions are uncommon, although it is worth mentioning in view of the ease of their detection on chest X‐ray.…”

“…Initial case reports of esophageal TB seemed to be advanced cases and consisted more of surgical reports. With the advent and availability of esophagogastroscopy, more and more medical case reports and series have been published . Now, with EUS availability, diagnostic abilities and yield have been enhanced, as are the number of cases.…”

Endoscopic ultrasound in the diagnosis of mediastinal diseases

“…Tuberculosis poses a challenge to healthcare professionals in its diagnosis and management. Esophageal tuberculosis is a form of extrapulmonary tuberculosis, which is rare [54]. …”