Tuberculous Paraspinal Abscess Invading Esophagus: A Rare Cause Of Dysphagia

Abstract

Esophageal involvement by mycobacterium tuberculosis is a rare entity even in the endemic regions. The common presenting complaint in esophageal tuberculosis are deglutition disorders in which patients primarily present with difficulty in swallowing. The most common site of esophageal involvement is the middle-third at the level of carina. Herein, the case of an adolescent boy is presented who had complains of dysphagia, abdominal pain along with weight loss for a month. On evaluation, he was found to have esophageal narrowing resulting in dysphagia. CT scan revealed a fistulous communication of tuberculous paraspinal abscess with the esophagus, which had resulted in dysphagia. The diagnosis of tuberculosis was made by using gold standard method of Polymerase Chain Reaction (PCR) of mycobacterium tuberculosis. He had marked symptomatic improvement within a month of starting anti tuberculous therapy (ATT) and was successfully treated with ATT for 9 months.

Primary Esophageal Tuberculosis With Dysphagia

“…In our patient, the location of a lesion at the level of the natural constriction of the esophagus by the aortic arch supports this theory. The other modality for the diagnosis of TB is PCR [16], which was not done in our patient. In our case, the biopsy report of necrotizing granuloma and prevalence of TB in our part of the world led us to the provisional diagnosis of TB in this case.…”