Extrapulmonary tuberculosis presenting with proximal esophageal fistula and abdominal lymphadenopathy in a young man: A case report

Table 1 Timeline of clinical course, imaging and treatment

Time point	Key events and findings
Month-6 to 0	Onset and progression of epigastric pain, dyspepsia and weight loss; initial endoscopy showing Helicobacter pylori gastritis; successful eradication but persistent symptoms and new dysphagia
Month 0	Barium swallow: Proximal esophageal deviation and outpouching; baseline CT: Circumferential proximal esophageal thickening, subdiaphragmatic lymphadenopathy (largest node 22 mm × 16 mm), diffuse pancreatic enlargement (head AP diameter 32 mm); baseline weight about 64 kg
Month 1	Repeat endoscopy: Very short blind-ended proximal esophageal fistula at 18 cm from incisors; EUS: Multiple enlarged subdiaphragmatic nodes; EUS-FNA: Necrotizing granulomatous lymphadenitis consistent with TB; IGRA positive; initiation of 4-drug anti-TB therapy
Month 2	Transient paradoxical reaction: Worsening abdominal pain; CT: Increase in lymph node size (largest 26 mm × 18 mm) with more central necrosis; no new sites of disease; adherence confirmed; regimen continued unchanged; weight about 66 kg
Month 3–4	Improvement in dysphagia (complete resolution by 3-4 months); progressive reduction in abdominal pain; weight gain to 68-69 kg
Month 6	Near-complete resolution of abdominal pain; weight about 70 kg; interim imaging (not shown) indicating decreasing lymph node size and pancreatic dimensions
Month 9	Patient asymptomatic; weight about 72 kg; continued HR therapy; MDT decision to complete 12 months in total
Month 12	Completion of 12-month anti-TB course; barium swallow: No residual fistula; CT: Near-complete regression of lymphadenopathy (largest node about 7 mm), pancreatic head AP diameter about 24 mm with normal contour; weight about 74 kg
Month 18 (follow-up)	Continued clinical well-being; no recurrence of symptoms (telephone follow-up)

CT: Computed tomography; TB: Tuberculosis; HR: Isoniazid (H) and rifampicin (R); MDT: Multidisciplinary team; AP: Anteroposterior; EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration; IGRA: Interferon-γ release assay.