Primary tuberculosis of the esophagus. Report of a clinical case
Hinojosa Domínguez, E.; Corral Medina, C.; Corral Medina, A.
Revista de Gastroenterologia de Mexico 42(1): 41-47
1977
ISSN/ISBN: 0375-0906 PMID: 616975 Document Number: 4506
A case of primary tuberculosis of the esophagus is presented. This is a rare disease not only in Alexico but in the entire world. At the present time there are only about one hundred and fifty case reported in the world literature. It is known that secondary tuberculosis of the esophagus is more common than primary, and occurs as a final complication of primary pulmonary tuberculosis. The patient does not have tuberculosis in any other part of her body. The basis for suspecting that it is a primary disease is the fact that she drinks cow's milk from a clandestine dairy, which she does not boíl; thus explaining the source and portal of entry. A predisposing factor was a hiatal hernia complicated with esophagitis and ulceration of the inferior third of the esophagus, which were diagnosed endoscopically. These conditions probably facilitated the entrance of the bacilus because as in tact esophageal mucosa is very resistant to the entrance of such organisms. Labcratory diagnosis was not possible because no specific alterations are found. Radiologically, images compatible with neoplasm or its complications, such as fistulas (as in this case), are observed. Endoscopio examination is of vital importance because, apart from direct visualization, biopsies can be taken and this is the best method, along with radiology, for long term follow-up. The treatment of choice is with antitubercular drugs. In cases of stenosis caused by retractile scars some authorities, such as Annamalai (India), recommend surgery. In this case a gastrostomy was performed in order to feed the patient and to free the esophagus of trauma. This, together with the antitbuercular treatment and corticosteroids, contributed to the patients improvement. She remains in radiological and endoscopical follow-up.
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