Hu Chunxiao, Chen Yanping, Ye Xiaohua
Department of Gastroenterology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, PR China.
Department of Gastroenterology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, PR China.
Int J Surg Case Rep. 2024 Feb;115:109313. doi: 10.1016/j.ijscr.2024.109313. Epub 2024 Jan 28.
Esophageal tuberculosis (ET) is a rare form of infectious esophagitis. Here, we present a case of primary ET in an immunocompetent patient with dysphagia.
Esophagogastroduodenoscopy (EGD) revealed a submucosal tumor (SMT)-like lesion in the distal esophagus. Subsequent endoscopic ultrasonography (EUS) showed ulceration, esophageal wall discontinuities, thickening, and hypoechoic masses. Histopathological analysis confirmed a tuberculoid granuloma within the lesion. Imaging studies ruled out pulmonary tuberculosis and lymph node involvement. The patient received six months of antituberculosis treatment, resulting in significant improvement on follow-up EGD.
ET is often misdiagnosed due to its rarity and nonspecific symptoms. In this case, the clinical presentation of dysphagia, combined with the characteristic findings on EGD and EUS, led to the diagnosis of primary esophageal tuberculosis.
Prompt consideration of ET in dysphagia patients with SMT-like lesions and timely initiation of appropriate antituberculosis treatment can improve clinical outcomes and help avoid unnecessary surgeries.
食管结核(ET)是一种罕见的感染性食管炎形式。在此,我们报告一例免疫功能正常的吞咽困难患者的原发性食管结核病例。
食管胃十二指肠镜检查(EGD)显示食管远端有一个类似黏膜下肿瘤(SMT)的病变。随后的内镜超声检查(EUS)显示有溃疡、食管壁连续性中断、增厚及低回声肿块。组织病理学分析证实病变内有结核样肉芽肿。影像学检查排除了肺结核和淋巴结受累。患者接受了六个月的抗结核治疗,随访EGD显示病情有显著改善。
由于食管结核罕见且症状不具特异性,常被误诊。在本病例中,吞咽困难的临床表现,结合EGD和EUS的特征性表现,导致原发性食管结核的诊断。
对于有类似SMT病变的吞咽困难患者,及时考虑食管结核并及时开始适当的抗结核治疗可改善临床结局,并有助于避免不必要的手术。