Case Report
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World J Gastrointest Endosc. Nov 16, 2013; 5(11): 581-583
Published online Nov 16, 2013. doi: 10.4253/wjge.v5.i11.581
Esophageal tuberculosis presenting with hematemesis
Samit S Jain, Piyush O Somani, Rajeshkumar C Mahey, Dharmesh K Shah, Qais Q Contractor, Pravin M Rathi
Samit S Jain, Piyush O Somani, Dharmesh K Shah, Qais Q Contractor, Pravin M Rathi, Department of Gastroenterology, Bai Yamunabai Laxman Nair Hospital, Topiwala National Medical College, Mumbai 400008, India
Rajeshkumar C Mahey, Department of General Surgery, Bai Yamunabai LaxmanNair Hospital, Topiwala National Medical College, Mumbai 400008, India
Author contributions: Jain SS, Somani PO, Mahey RC and Shah DK designed the research; Jain SS, Somani PO and Shah DK performed the research; Contractor QQ and Rathi PM analyzed the data; Jain SS and Somani PO wrote the paper.
Correspondence to: Pravin M Rathi, Professor, Head, Department of Gastroenterology, Bai Yamunabai Laxman Nair Hospital, Topiwala National Medical College, Dr A L Nair Road, Mumbai Central, Mumbai 400008, India. rathipmpp@gmail.com
Telephone: +91-22-23016139 Fax: +91-22-23021168
Received: August 1, 2013
Revised: September 14, 2013
Accepted: October 16, 2013
Published online: November 16, 2013
Processing time: 109 Days and 16.4 Hours
Abstract

Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy (EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.

Keywords: Esophageal tuberculosis; Esophagogastroduodenoscopy; Hematemesis

Core tip: Esophageal tuberculosis is very rare, constituting about 0.3% of gastrointestinal tuberculosis cases. Esophageal tuberculosis presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few case reports of esophageal tuberculosis presenting with hematemesis due to esophageal ulceration. We report a patient with hematemesis that was later attributed to the erosion of tuberculous subcarinal lymph nodes into the esophagus.