Foregut tuberculosis: Too close but miles apart

Table 1 Esophageal tuberculosis

Ref.	Age, sex	Presentation	Diagnosis and treatment
Diallo et al[11]	58-year-old man	Dysphagia for 3 months with non-quantified weight loss, anorexia and fever	Esophageal biopsy showed caseous granuloma. Treated with ATT
Mao et al[12]	27-year-old woman	1-month history of progressive dysphagia, accompanied by post-sternal pain, belching, acid regurgitation, heartburn, and nausea	Esophageal endoscopy with biopsy performed showed interstitial granulation tissue. TB PCR was positive. Treated with ATT
Savage et al[13]	46-year-old woman	6-week history of dysphagia and retrosternal chest pain unrelieved by antacids	Barium swallow showed a 10 cm plaque-like mid-esophageal lesion. Biopsies taken during esophagoscopy were inconclusive. Repeat biopsy 1 month later demonstrated caseating granulomata in the submucosa. Treated with ATT
Savage et al[13]	26-year-old man	6-week history of dysphagia for solids and retrosternal pain	Barium meal: Extrinsic compression in the mid-esophagus. Chest X ray: Sub carinal lymphadenopathy; Mantoux test: Strongly positive at 1:10000; Endoscopic biopsies were non-specific. A diagnosis of esophageal TB was made on radiological appearances and strongly positive Mantoux test. Treated with ATT
Han et al[15]	56-year-old woman	2-week history of mild dysphagia	Esophageal biopsies showed numerous epithelioid caseating granulomas. The PPD skin test, T-SPOT. TB assay and polymerase chain reaction testing for MTB were positive. Treated with ATT
Jain et al[17]	15-year-old man	Bouts of hematemesis and melena for 2 days	EGD followed with biopsy revealed caseating epithelioid granulomas with lymphocytic infiltrate. PCR positive for TB. Treated with ATT
Khan et al[18]	25-year-old man	1-month progressive dysphagia for both solids and liquids associated with epigastric pain	Endoscopy followed with biopsy showed granulation tissue. Cultures of biopsied tissue were positive for MTB PCR was positive. Treated with ATT
Zahra et al[22]	27-year-old man	Burning chest pain for 3 months; Intermittent fever, weight loss, loss of appetite for few weeks	EGD followed by biopsy revealed granulomatous caseating lesion. Nucleic acid amplification test was positive for TB. Treated with ATT
Abid et al[23]	45-year-old woman	Progressive dysphagia and weight loss (8 kg) for 6 months	Endoscopic biopsy of esophageal ulcers revealed granulomatous changes. AFB staining and MTB complex PCR was negative. Treated with ATT
Abid et al[23]	80-year-old woman	Massive hematemesis without any history of dysphagia, odynophagia, regurgitation	Endoscopy showed multiple ulcers in proximal esophagus, biopsy of which received granulomatous lesions. AFB stain for MTB was negative, but a positive PCR. Patient died next day because of massive hematemesis
Abid et al[23]	85-year-old woman	Dysphagia and cough. 5 kg weight loss in 2 months	Endoscopic biopsy of a hyperemic patch in esophagus revealed granulomatous changes. AFB stain and PCR for MTB was negative. Patient died 3 days after hospitalization due to aspiration pneumonia
Abid et al[23]	29-year-old man	Odynophagia and retrosternal burning	Endoscopic biopsy of esophageal ulcer revealed positive MTB PCR, although cultures showed no growth. Treated with ATT
Mohan et al[24]	30-year-old woman	Fever, malaise and decreased appetite for 3 weeks. She had dysphagia and cough during swallowing for 4 days	Chest X ray: Miliary TB. Upper GI endoscopy showed ulcer, biopsy of which revealed chronic inflammation with granuloma. Treated with ATT
Olson et al[25]	35-year-old man	2 months of progressive dysphagia and odynophagia	AFB culture positive for MTB from surgically removed mediastinal lymph node. Treated with ATT
Fujiwara et al[26]	82-year-old man	Progressive dysphagia	Esophagoscopy with biopsy showed epithelioid granulation. CT chest showed enlarged sub carinal lymph nodes. Responded to ATT
Hu et al[27]	75-year-old man	Progressive dysphagia for 1 month	EUS followed by histopathology showed tuberculoid granuloma. PPD skin test and TB spot both were positive
Mahmoudi et al[28]	55-year-old woman	Progressive dysphagia for 3 months, weight loss, loss of appetite, intermittent fever	EGD followed by histopathological examination revealed epithelioid cell granulomas without caseous necrosis. Sputum examination for acid-fast bacilli was positive. Treated with ATT
Salad et al[29]	23-year-old man	Cough on eating and halitosis, mild weight loss	EGD followed with biopsy showed inflammatory lesions with epithelioid granulomas. Treated with ATT
Khanna et al[30]	60-year-old man	Progressive dysphagia for 4 months with loss of weight and appetite	Endoscopy followed by biopsy showed epithelioid granulomas with caseating necrosis. TB PCR was positive. Treated with ATT
Danna et al[31]	69-year-old man	Persistent fever and dysphagia for 4 weeks	EGD followed showed deep esophageal ulcerations followed with biopsy with special stains positive for AFB. Treated with ATT
Baleguli et al[32]	24-year-old woman	1 month of dysphagia and odynophagia associated with low-grade fevers, dry cough, night sweats, anorexia, sore throat, and pound weight loss	EGD followed with esophageal biopsies showed active ulcerative and granulomatous esophagitis with mycobacterial organisms. AFB culture grew MTB and MTB PCR was positive. Treated with ATT

AFB: Acid-fast bacilli; ATT: Anti-tuberculosis therapy; EGD: Esophagogastroduodenoscopy; EUS: Endoscopic ultrasonography; GI: Gastrointestinal; MTB: Mycobacterium tuberculosis; PPD: Purified protein derivative; TB: Tuberculosis; PCR: Polymerase chain reaction.