Subedi Ananta, Sharma Rakshya
Internal Medicine, Avera McKennan Hospital & University Health Center, Sioux Falls, USA.
Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.
Cureus. 2022 Oct 11;14(10):e30174. doi: 10.7759/cureus.30174. eCollection 2022 Oct.
About a quarter of the world's population is infected with tuberculosis (TB). It is one of the leading causes of death worldwide. However, the prevalence of TB in the United States is rare. Pulmonary TB is the commonest form of TB. Most patients with TB present with pulmonary symptoms. Extrapulmonary TB usually presents with symptoms related to the organ system involved and can present with very unusual symptoms. TB presenting with dysphagia is uncommon, and spinal TB presenting with dysphagia is very unusual. A 57-year-old woman presented to the emergency department with a four-month history of dysphagia and chest pain. She was undergoing an outpatient workup of her symptoms that included esophagogastroduodenoscopy, gastric emptying study, and computed tomography (CT) scan of the chest, which showed incidental findings of a focus in the thoracic spine. It was followed by a bone scan, and the results were concerning for malignancy. She was awaiting an oncology appointment when she presented to us. A basic workup after her presentation that includes complete blood count, comprehensive metabolic panel, troponin, chest x-ray, and electrocardiogram was unrevealing. Magnetic resonance imaging (MRI) of the thoracic spine showed findings suggestive of tuberculous spondylitis, tuberculous paraspinal, and prevertebral abscesses. Chest CT was repeated, which showed mass effect and erosion on the posterior esophageal wall with anterior displacement of the esophagus. Tissue biopsy revealed acid-fast bacilli (AFB) on AFB stain, and the culture grew . She was successfully treated with the antitubercular regimen of rifampin, isoniazid, ethambutol, and pyrazinamide. TB can present with a myriad of symptoms, and although rare, it can present with symptoms like dysphagia. In patients with a history of travel to or immigration from an endemic region, previous infection, and immunosuppression, TB should be considered as one of the differential diagnoses even for unusual symptoms like dysphagia.
全球约四分之一的人口感染了结核病（TB）。它是全球主要死因之一。然而，结核病在美国的患病率很低。肺结核是结核病最常见的形式。大多数结核病患者表现出肺部症状。肺外结核通常表现为与受累器官系统相关的症状，可能会出现非常不寻常的症状。以吞咽困难为表现的结核病并不常见，而以吞咽困难为表现的脊柱结核则极为罕见。一名57岁女性因吞咽困难和胸痛4个月就诊于急诊科。她正在接受针对其症状的门诊检查，包括食管胃十二指肠镜检查、胃排空研究以及胸部计算机断层扫描（CT），胸部CT偶然发现胸椎有一个病灶。随后进行了骨扫描，结果提示可能为恶性肿瘤。她在等待肿瘤学预约时前来我们这里就诊。她就诊后进行的基本检查，包括全血细胞计数、综合代谢指标、肌钙蛋白、胸部X线和心电图，均未发现异常。胸椎磁共振成像（MRI）显示有结核性脊柱炎、椎旁结核和椎前脓肿的表现。再次进行胸部CT检查，显示食管后壁有占位效应和侵蚀，食管向前移位。组织活检在抗酸杆菌（AFB）染色中发现抗酸杆菌，培养结果为……她接受了利福平、异烟肼、乙胺丁醇和吡嗪酰胺的抗结核治疗方案，治疗成功。结核病可表现出多种症状，虽然罕见，但也可能出现如吞咽困难等症状。对于有来自结核病流行地区旅行史或移民史、既往感染史以及免疫抑制的患者，即使出现如吞咽困难等不寻常症状，也应将结核病视为鉴别诊断之一。
