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. 2013 Nov 16;5(11):581-3.
doi: 10.4253/wjge.v5.i11.581.

Esophageal tuberculosis presenting with hematemesis

Samit S Jain  1 , Piyush O Somani, Rajeshkumar C Mahey, Dharmesh K Shah, Qais Q Contractor, Pravin M Rathi
Affiliations

Esophageal tuberculosis presenting with hematemesis

Samit S Jain et al. World J Gastrointest Endosc. .

Abstract

Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy (EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.

Keywords: Esophageal tuberculosis; Esophagogastroduodenoscopy; Hematemesis.

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Figures

Figure 1
Figure 1
Esophagogastroduodenoscopy showing eccentric ulcerative lesion involving 50% of circumference of the esophagus (white arrow).
Figure 2
Figure 2
Computerised tomography of the thorax showing thickening of the mid-esophagus (red arrow) along with Ryle’s tube in situ (white arrow). Right sided pleural effusion seen (blue arrow).
Figure 3
Figure 3
Histopathological examination of esophageal ulcer biopsy showing epitheloid cell granulomas (red arrows) with caseation (black arrow) in the exudate suggestive of esophageal tuberculosis (HE stain x 10).
Figure 4
Figure 4
Esophagogastroduodenoscopy after 6 mo of anti-tuberculosis therapy showing resolution of esophageal ulcer along with scarring (red arrow) and mucosal tags (white arrow).
See this image and copyright information in PMC

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