Tuberculous Broncho-Esophageal Fistula in an Adult Male: A Rare Case Managed Conservatively.

Abstract

Introduction: Tuberculosis (TB) is a widespread infectious disease caused by Mycobacterium tuberculosis. It predominantly affects the lungs but can involve any organ in the body. Tracheo-oesophageal fistula (TEF) is one of the rare extrapulmonary manifestations of TB.

Case report: A 27-year-old male, otherwise healthy, reported to our outpatient department with complaints of fever, persistent cough, and significant weight loss. Subsequently, he was diagnosed with tuberculous tracheo-oesophageal fistula and pulmonary tuberculosis.

Discussion: The patient had an elevated ESR (52 mm) and underwent multiple imaging studies, including two normal barium swallow tests. Upper gastrointestinal endoscopy (UGIE) revealed two esophageal ulcers, one with a fistulous tract. Biopsy results suggested chronic esophagitis with granulomatous inflammation. Contrast-enhanced CT (CECT) of the thorax showed esophageal irregularities, air foci, and contrast extravasation into the bronchi, along with mediastinal lymphadenopathy and centrilobular nodules. Clinical and investigative findings suggested pulmonary tuberculosis with a tracheoesophageal fistula. The patient was discharged on a six-month antitubercular regimen with nutritional support via a nasogastric tube. Stent installation was planned if follow-up results were unfavorable.

Conclusion: Although tuberculosis is highly prevalent in India, TEF of tuberculous origin has been infrequently documented, particularly in young, healthy, immunocompetent individuals. The patient was successfully cured after initiating antitubercular therapy and subsequent follow-up.