Mohamed L, Elsayed G, Kambal M, Soliman R, Sirelkhatim S, Gadour E. Extrapulmonary tuberculosis presenting with proximal esophageal fistula and abdominal lymphadenopathy in a young man: A case report. World J Clin Cases 2026; 14(18): 119927 [DOI: 10.12998/wjcc.119927]
Corresponding Author of This Article
Eyad Gadour, MD, CCST, FACP, FRCP, MRCP, Professor, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Dammam 32253, Saudi Arabia. eyadgadour@doctors.org.uk
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Gastroenterology & Hepatology
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case-report
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Mohamed L, Elsayed G, Kambal M, Soliman R, Sirelkhatim S, Gadour E. Extrapulmonary tuberculosis presenting with proximal esophageal fistula and abdominal lymphadenopathy in a young man: A case report. World J Clin Cases 2026; 14(18): 119927 [DOI: 10.12998/wjcc.119927]
World J Clin Cases. Jun 26, 2026; 14(18): 119927 Published online Jun 26, 2026. doi: 10.12998/wjcc.119927
Extrapulmonary tuberculosis presenting with proximal esophageal fistula and abdominal lymphadenopathy in a young man: A case report
Lama Mohamed, Ghassan Elsayed, Mohammed Kambal, Rami Soliman, Sufian Sirelkhatim, Eyad Gadour
Lama Mohamed, Ghassan Elsayed, Mohammed Kambal, Rami Soliman, Sufian Sirelkhatim, Department of Gastroenterology, Mediclinic Middle East Hospital, Abu Dhabi W67, United Arab Emirates
Eyad Gadour, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
Eyad Gadour, Department of Intenral Medicine, Faculty of Medicine, Zamzam Univeristy College, Khartoum 11113, Sudan
Co-first authors: Lama Mohamed and Ghassan Elsayed.
Author contributions: Mohamed L, Elsayed G, Kambal M, Soliman R, Sirelkhatim S, and Gadour E contributed to the conception and design of the case report; Gadour E performed the clinical examination, endoscopy, and obtained informed consent from the patient; Mohamed L, Kambal M, Soliman R, and Sirelkhatim S participated in data collection, literature review, and manuscript drafting; Elsayed G provided senior clinical oversight, critical revision of the manuscript, and supervised the overall project; Mohamed L and Elsayed G made crucial and indispensable contributions towards the completion of the project, and thus, qualified as the co-first authors of the paper; all authors reviewed and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
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).
Corresponding author: Eyad Gadour, MD, CCST, FACP, FRCP, MRCP, Professor, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Dammam 32253, Saudi Arabia. eyadgadour@doctors.org.uk
Received: February 10, 2026 Revised: March 14, 2026 Accepted: May 14, 2026 Published online: June 26, 2026 Processing time: 125 Days and 9.8 Hours
Abstract
BACKGROUND
Abdominal and esophageal tuberculosis (TB) are uncommon manifestations of Mycobacterium infection and often mimic malignant or inflammatory conditions, leading to delayed diagnosis. Esophageal TB complicated by fistula formation is particularly rare, and pancreatic involvement can closely resemble pancreatic carcinoma or autoimmune pancreatitis.
CASE SUMMARY
A 32-year-old man from a TB-endemic region presented with persistent epigastric pain, progressive dysphagia and unintentional weight loss despite successful Helicobacter pylori eradication. Cross-sectional imaging revealed circumferential thickening of the proximal esophagus, diffuse pancreatic enlargement and pathological subdiaphragmatic lymphadenopathy. Barium swallow suggested a short, blind-ended proximal esophageal fistulous tract. Repeat upper gastrointestinal endoscopy confirmed a very short proximal esophageal fistula at 18 cm from the incisors, exposing the esophageal adventitia without a demonstrable communication to adjacent structures. Endoscopic ultrasound (EUS) demonstrated multiple enlarged subdiaphragmatic lymph nodes, which were sampled by fine-needle aspiration. Cytology showed florid granulomatous inflammation with multinucleated giant cells, highly suggestive of TB, although Ziehl–Neelsen staining for acid-fast bacilli was negative. Based on the clinical, epidemiological and imaging context, a diagnosis of extrapulmonary TB with intra-abdominal lymph node involvement, associated proximal esophageal fistula and probable pancreatic TB was made in a multidisciplinary team setting. The patient received standard four-drug anti-TB therapy (isoniazid, rifampicin, pyrazinamide and ethambutol). At 2 months, he developed worsening abdominal pain and radiological progression of lymphadenopathy, consistent with a paradoxical TB reaction; adherence was confirmed and there was no evidence of drug resistance. Anti-TB therapy was continued and extended to 12 months because of fistulating esophageal disease and bulky pancreatic involvement. He achieved complete clinical recovery with radiological resolution of the esophageal fistula, near-complete regression of lymphadenopathy and marked reduction in pancreatic size.
CONCLUSION
This unusual triad of proximal esophageal fistula, intra-abdominal tuberculous lymphadenitis and imaging-suggested pancreatic TB in an immunocompetent young man without pulmonary involvement underlines the need to consider TB in the differential diagnosis of unexplained esophageal fistula, abdominal lymphadenopathy and pancreatic enlargement, particularly in patients from endemic regions. EUS-guided tissue acquisition is a minimally invasive and highly accurate modality for establishing the diagnosis of intra-abdominal tuberculous lymphadenitis and guiding timely therapy.
Core Tip: Extrapulmonary tuberculosis (TB) may present with atypical and misleading features that mimic malignancy. We report a young man from a TB-endemic region with persistent abdominal pain, dysphagia and weight loss after successful Helicobacter pylori eradication who was found to have a very short proximal esophageal fistula, diffuse pancreatic enlargement and subdiaphragmatic lymphadenopathy. Endoscopic ultrasound (EUS)-guided fine-needle aspiration of abdominal lymph nodes revealed granulomatous inflammation that was highly suggestive of TB. Standard anti-TB therapy was extended to 12 months because of fistulating esophageal disease and probable pancreatic involvement. The patient reached complete clinical and radiological resolution, despite an interim paradoxical reaction. This case underscores the need to consider TB in patients presenting with unexplained esophageal fistula and abdominal lymphadenopathy, and illustrates the pivotal diagnostic role of EUS-guided tissue sampling.
