Esophageal tuberculosis

Excerpt

A 57-year-old man presented with a one-week history of odynophagia, diarrhea, and fever. Physical examination was unremarkable. Laboratory tests showed red blood cell count of 4.17 × 10¹²/L (normal range, 4.3–5.8 × 10¹²/L), leukocyte count of 9.94 × 10⁹/L (normal range, 3.5–9.5 × 10⁹/L), platelet count of 381 × 10⁹/L (normal range, 125–350 × 10⁹/L), hemoglobin of 105 g/L (normal range, 130–175 g/L), erythrocyte sedimentation rate of 98 mm/h (normal range, 0–20 mm/h), C-reaction protein of 52 mg/L (normal range, 0–5 mg/L), total serum protein of 61 g/L (normal range, 65–85 g/L) and serum albumin of 29 g/L (normal range, 40–55 g/L). Esophagogastroduodenoscopy showed deep longitudinal ulcers in the lower esophageal region at 32 to 40 cm from the incisor (Fig. 1A). Colonoscopy revealed ulcer lesions in the ileocecal valve and ascending colon. No enlarged mediastinal lymph nodes were found in adjacent areas by computed tomography (CT) scan. Esophageal and colonic biopsy specimens (H&E staining) showed chronic inflammation with lymphocytic infiltration and caseating granulomas (Fig. 1B). The histopathological features of the esophageal and colonic biopsies indicated the possibility of esophageal tuberculosis. Chest CT showed no signs of pulmonary tuberculosis. The purified protein derivative (PPD) skin test, T-SPOT.TB assay and polymerase chain reaction testing for M tuberculosis were positive. The human immunodeficiency virus (HIV) enzyme-linked immunosorbent assay (ELISA) test was negative. Immunosuppressant conditions were excluded in this patient. Finally, a diagnosis of primary esophageal and intestinal tuberculosis was made. Esophageal tuberculosis is extremely rare and symptoms are related to the extent of infection [1‐3]. The patient received a standard oral antituberculous regimen. Repeat endoscopy examination showed that the esophageal and colonic ulcers healed after 12 months of antituberculosis treatment.

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