Esophageal TB is an uncommon cause of dysphagia and a TE fistula. In general, dysphagia may be neurologic, structural, or related to drugs (benzodiazepines, antihistamines, and anticholinergics).1 A history of immediate coughing with drinking or eating and radiographic evidence of pneumonia is most consistent with a TE fistula. In patients who describe fever, night sweats, weight loss, and anorexia, esophageal cancer or mediastinal lymphoma is possible. Granulomatous infections also should be considered. Actinomycosis, syphilis, or TB rarely have been determined to be the cause of TE fistulas.2 Both malignancy and infections can cause cervical adenopathy and systemic symptoms. A travel history to Mexico, productive cough, and cervical adenopathy are most consistent with TB or coccidiomycosis.