Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2020; 8(3): 645-651
Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.645
Esophageal tuberculosis complicated with intestinal tuberculosis: A case report
Lei Mao, Xue-Ting Zhou, Ji-Pin Li, Jun Li, Fang Wang, Hui-Min Ma, Xiao-Lu Su, Xiang Wang
Lei Mao, Xue-Ting Zhou, Ji-Pin Li, Jun Li, Fang Wang, Hui-Min Ma, Xiao-Lu Su, Xiang Wang, Department of Gastroenterology, The Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Author contributions: Wang X and Mao L were attending physicians for the patient, reviewed the literature and contributed to manuscript drafting; Zhou XT, Li JP and Li J reviewed the literature and contributed to manuscript drafting; Wang F and Ma HM performed the upper gastrointestinal endoscopy and colonoscopy, and contributed to manuscript drafting; Su XL analyzed and interpreted the histopathological findings; Wang X was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
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 declare that they have no conflict of interest.
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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Xiang Wang, MAMS, Associate Professor, Chief Physician, Department of Gastroenterology, The Second Hospital of Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou 730000, Gansu Province, China. wangxiang@lzu.edu.cn
Received: November 22, 2019
Peer-review started: November 22, 2019
First decision: December 3, 2019
Revised: December 10, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: February 6, 2020
Processing time: 75 Days and 11.5 Hours
Abstract
BACKGROUND

Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis (ET) is still rare. Intestinal tuberculosis (ITB) is relatively more common, but there are few reports of ET complicated with ITB. We report a case of secondary ET complicated with ITB in a previously healthy patient.

CASE SUMMARY

A 27-year-old female was hospitalized for progressive dysphagia, retrosternal pain, acid regurgitation, belching, heartburn, and nausea. Upper gastrointestinal endoscopy showed a mid-esophageal ulcerative hyperplastic lesion. Endoscopic ultrasonography showed a homogeneous hypoechoic lesion, with adjacent enlarged lymph nodes. Biopsy histopathology showed inflammatory exudation, exfoliated epithelial cells and interstitial granulation tissue proliferation. Colonoscopy revealed a rat-bite ulcer in the terminal ileum and a superficial ulcer in the ascending colon, near the ileocecal region. The ileum lesion biopsy showed focal granulomas with caseous necrosis. Polymerase chain reaction for Mycobacterium tuberculosis was positive in the esophageal and ileum lesion biopsies. The T-cell spot tuberculosis test was also positive. The patient was diagnosed with secondary ET infiltrated by mediastinal lymphadenopathy and complicated with ITB, possibly from the Mycobacterium tuberculosis-infected esophageal lesion. After 2 mo of anti-tuberculosis therapy, her symptoms improved significantly, and upper gastrointestinal endoscopy showed healing ulcers.

CONCLUSION

When dysphagia or odynophagia occurs in patients at high-risk for tuberculosis, ET should be considered.

Keywords: Esophageal tuberculosis; Intestinal tuberculosis; Dysphagia; Endoscopic ultrasonography; Tuberculosis drug therapy; Case report

Core tip: Esophageal (ET) and intestinal tuberculosis are rare forms of tuberculosis, and there are few reports of ET complicated with intestinal tuberculosis. Our patient presented with progressive dysphagia, but no other significant medical history. Lesions in the esophagus and colon were found to be Mycobacterium tuberculosis positive. The patient responded well to anti-tuberculosis therapy. This case demonstrates that ET should be suspected when patients at high risk for tuberculosis present with dysphagia or odynophagia.