Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2019; 11(9): 373-380
Published online Sep 27, 2019. doi: 10.4240/wjgs.v11.i9.373
Primary esophageal tuberculosis mimicking esophageal carcinoma on computed tomography: A case report
Muhammad Salman Khan, Muhammad Hassaan Arif Maan, Amir Humza Sohail, Wasim Ahmed Memon
Muhammad Salman Khan, Wasim Ahmed Memon, Department of Radiology, Aga Khan University, Karachi 74800, Pakistan
Muhammad Hassaan Arif Maan, Medical College, Aga Khan University, Karachi 74800, Pakistan
Amir Humza Sohail, Department of Surgery, New York University Winthrop Hospital, New York, NY 11501, United States
Author contributions: Khan MS provided the case details, figures, and wrote the case details; Maan MHA did the literature review and wrote the case details and discussion; Sohail AH wrote the introduction and discussion; Memon WA was involved in writing the discussion and final editing of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that no conflict of interest exists.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Muhammad Hassaan Arif Maan, Medical Student, Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan. m.hassaanmaan@gmail.com
Telephone: +92-32-17979496 Fax: +92-21-34934294
Received: May 20, 2019
Peer-review started: May 20, 2019
First decision: August 2, 2019
Revised: August 24, 2019
Accepted: September 10, 2019
Article in press: September 10, 2019
Published online: September 27, 2019
Processing time: 131 Days and 20.1 Hours
Abstract
BACKGROUND

Tuberculosis (TB) has a rare extrapulmonary manifestation known as esophageal tuberculosis, accounting for 0.2% of total TB patients. Esophageal TB typically presents with dysphagia, with retrosternal pain or odynophagia, but generalized symptoms such as low-grade fever, decreased appetite, and weight loss are also observed. Esophageal carcinoma and Crohn’s disease of the esophagus are important differential diagnoses with similar presentation.

CASE SUMMARY

We present a case of a 25-year-old male, who presented with esophageal TB mimicking an esophageal carcinoma. Lab work-up, Mantoux test, and chest X-ray were normal. Barium-swallow examination showed moderate dilatation of distal esophagus with a nodular and irregular mucosa. Computed tomography showed significant thickening of thoracic and distal esophagus with infiltration into the lesser omentum and large, centrally necrotic lymph nodes on gastro-hepatic ligament suggestive of a possible malignancy. Esophagoscopy was performed and a biopsy of mural thickening was performed and sent for histopathological examination. The histopathology report and TB-polymerase chain reaction confirmed the diagnosis of esophageal TB. The patient was started on anti-tuberculous therapy (ATT), and complete resolution of symptoms and disease was achieved in 6 mo.

CONCLUSION

Esophageal TB is an extremely rare, yet important differential diagnosis in a patient presenting with dysphagia. Esophageal TB can mimic esophageal carcinoma on computed tomography scan. The patient responded well to a complete course of ATT.

Keywords: Case report; Esophageal tuberculosis; Esophageal carcinoma; Computed tomography

Core tip: Tuberculosis (TB) has a rare extrapulmonary manifestation known as esophageal tuberculosis, which accounts for 0.2% of total TB patients. Esophageal TB typically presents with dysphagia and retrosternal pain. We present a case of a 25-year-old male, who presented with esophageal TB mimicking an esophageal carcinoma. The lab work-up and chest X-ray were unremarkable. Esophagoscopy was performed and a biopsy of mural thickening was taken. The histopathology report and TB-polymerase chain reaction test confirmed the diagnosis of esophageal TB. The patient was started on anti-tuberculous therapy, and complete resolution of symptoms and disease was achieved in 6 mo.