A RARE CAUSE OF ESOPHAGEAL DYSPHAGIA – SECONDARY
ESOPHAGEAL TUBERCULOSIS
Introduction
Gastrointestinal tuberculosis accounts for 1% to 3
% of all TB cases worldwide.
Common manifestations are Esophageal TB,
Gastric and Gastroduodenal TB, TB of small and
large intestine, Rectal and anal TB, and peritoneal
TB [1] [2].
Common causes of dysphagia are esophageal
(mechanical obstruction and motor disorders) and
oropharyngeal (neuromuscular disease, upper
esophageal sphincter lesions).
Main diagnostic tests to evaluate dysphagia
include modified barium swallow, barium
esophagram, endoscopy, and manometry [3].
Endoscopy offers diagnostic information and a
route of therapeutic intervention [4].
Objective Statement
We present a rare case of esophageal dysphagia
due to secondary tuberculosis.
Patient’s CT chest: : diffuse bilateral lung disease
with areas of cavitation.
(Image obtained with permission from Northeast
RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
Georgia Medical Center, Gainesville, GA)
Shahraiz Shah Rizvi , MBBS. Vidya Baleguli , MBBS. Merin Varghese , MD. Jawad
1 1 2
Ahmed Ilyas3, MD, MS.
(1) GME Internal Medicine, Northeast Georgia Medical Center, Gainesville, GA;
(2) Department of Infectious Disease, Northeast Georgia Physician's Group, Gainesville, GA
(3) Atlanta Gastroenterology, Gainesville, GA
Case Presentation Discussion
24-year-old female with history of incarceration, polysubstance abuse, presented with a one month duration Esophageal tuberculosis is a rare condition that
of dysphagia associated with fevers, dry cough, night sweats, anorexia, and a 40 pound weight loss. accounts for 2.8% of all cases of gastrointestinal
Vital signs noted blood pressure of 96/60 mm Hg, temperature of 37.4 °C (99.3 °F), heart rate of 121 beats tuberculosis [5]. Esophageal involvement by
per minute, respiratory rate of 16 breaths per minute, oxygen saturation of 100%, and weight of 35.2 kg. tuberculosis occurs at the middle third of the
Patient was thin, pale with dry mucosa, whitish exudate on the oropharynx, but no swelling of uvula or esophagus at the level of carina. There are two
oropharynx. Normal breath sounds noted on lung auscultation. Abdominal examination was unremarkable. types of Esophageal TB; primary and secondary.
Primary TB exclusively involves the esophagus
Labs revealed white blood cell count of 10.2 K/uL, hemoglobin of 9.7 gm/dl, and hematocrit of 32.7%.
and is exceedingly rare. Secondary TB is
Inflammatory markers ESR and CRP were elevated. HIV test was non-reactive. TB Quantiferon gold was
associated with a primary TB focus and can spread
positive. Computed Tomography (CT) of the chest was significant for diffuse bilateral lung disease with
from lungs or mediastinal nodes to esophagus.
areas of cavitation.
Presents with dysphagia. Complications include
Sputum cultures returned positive for Mycobacterium tuberculosis (MTB). bleeding, perforation, fistula, esophageal strictures
Esophagogastroduodenoscopy (EGD) showed severe ulcerations of the oropharynx and focal ulceration in [6] [8]. CT of the chest shows tuberculous
the proximal to mid esophagus. lymphadenitis [6]. Diagnosis confirmed by
Esophageal biopsies showed active ulcerative and granulomatous esophagitis with mycobacterial histopathology and MTB polymerase chain
organisms. Furthermore, submucosa of esophagus displayed multifocal confluent noncaseating epithelioid reaction [7]. Treatment is anti-tubercular therapy
histiocytic granuloma with focal Langerhans' type giant cells and acid fast bacilli stain, and with four drugs (isoniazid, rifampicin,
immunohistochemical mycobacterial stain displayed infrequent mycobacterial organisms. pyrazinamide and ethambutol) for two months,
Further history from patient revealed that she has had previous close contact with a person with isoniazid followed by a period of four to six months with
resistant TB. two drugs (isoniazid and rifampin) [9], [10]. The
Patient was started on antitubercular therapy with Rifampin, Ethambutol, Pyrazinamide, and Moxifloxacin. indications for surgical interventions are fistulas,
strictures, and perforations [7].    
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