Chest Infections |

A Rare Cause of Unresolved Pneumonia FREE TO VIEW

Waseem Hajjar, MD
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King Khalid University Hospital, Riyadh, Saudi Arabia

Chest. 2014;146(4_MeetingAbstracts):152A. doi:10.1378/chest.1992786
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SESSION TITLE: Infectious Disease Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchoesophageal fistulas (BEF) are uncommon pathology in adults, the etiology being late presentation of congenital or acquired. Acquired (BEF) of tuberculous origin is uncommon and rare pathology. We present her a case of an acquired BEF of tuberculous origin in a patient who presented with a repetitive chest infection and pneumonia.

CASE PRESENTATION: 47 years old male patient, Complaining of cough, expectoration and fever on and off for a long time, nausea and vomiting, Repetitive chest infection and pneumonia mainly the left side, and loss of weight. Also he has chocking like symptoms and coughing when he drinks or eat liquid diet. Previous medical history he has adreno-cortical insufficiency for ? old TB 8 years ago and treated with anti TB medication for 2 years. Now he is on Prednisilone as replacement therapy. General exam was satisfactory, and vital signs OK, but only slight pyrexia 37.7 c Chest examination showed few crepitations in the left lower zone, but other systems examination was unremarkable. Laboratory Investigations were normal but ESR was 58, 3 samples of sputum negative for AFB. PPD negative. Hepatitis screen HIV negative. ABG, PFT,s, ECG, Echo cardiogram were all normal. gastrographin study showed: Broncho-esophageal fistula. Upper GI endoscopy showed: mild non specific esophagitis and at 34cm a thin fistula opening between the left lower bronchus (basal segment) and the esophagus lot of secretions around the fistula found, aspiration done. Esophageal aspirate and tissue biopsy showed (ZN) stain is positive for AAFB. he was admitted under the ID group for treatment of TB, Started as IV Medications in the form of: Ciprofloxacin 400 mg/IV, Rifampicin 600mg/IV, Isoniazid 300 mg/IV. NG tube inserted in the Duodenum under x ray screening. (Ensure feeding) started and anti TB medication through the NG tube. After 3 weeks under went Lt. thoracotomy and Dissection of the esophagus done with Identification of the fistula. The lymph nodes sent for histopathology and stapler at the bronchial side, and suturing in two layers at the esophagus side, and covering with pericardial fat as a buttress. Post operative the Patient continued on IV anti-tuberculous and steroid medications and started also on TPN. After 3 weeks Barium swallow done showed no leakage, oral diet and medications started.

DISCUSSION: Acquired (BEF) of tuberculous origin is uncommon and rare pathology. We present her a case of an acquired BEF of tuberculous origin in a patient who presented with a repetitive chest infection and pneumonia. diagnosis obtained prior to the surgical repair and good preparation to the patient. All these factors are essential in the success of the management in general.

CONCLUSIONS: Acquired (BEF) of tuberculous origin is uncommon and rare pathology, needs proper diagnosis, good preperation and treatment prior to the definitive surgical repair.

Reference #1: Jpn J Thorac Cardiovasc Surg. 2003 Jun;51(6):242-5. Benign acquired bronchoesophageal fistula in an adult. Tomiyama K1, Ishida H, Miyake M, Taki T.

Reference #2: Respiration. 2002;69(4):362-5. Bronchoesophageal fistulae secondary to tuberculosis. Lado Lado FL, Golpe Gomez A, Cabarcos Ortiz de Barron A, Antunez Lopez JR.

Reference #3: Endoscopy. 1997 Feb;29(2):146. Tuberculous bronchoesophageal fistula in a patient infected with the HIV virus. Ravera M.

DISCLOSURE: The following authors have nothing to disclose: Waseem Hajjar

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