Esophago-Mediastinal Fistula as a Complication of Disseminated Tuberculosis in an Immunocompetent Patient: A Case Report

Tuberculosis is a public health issue that affects people worldwide and continues to burden developing countries, remaining one of the main causes of morbidity and mortality globally. This study reports a case of disseminated tuberculosis in an immunocompetent patient complicated by an esophago-mediastinal fistula. This descriptive, retrospective case report was based on medical record review and conducted in accordance with ethical principles for human research. The case involves a 24-year-old male with no comorbidities, admitted with a wasting syndrome, daily afternoon fever, and back pain. MRI showed an extensive paravertebral and iliopsoas collection associated with vertebral body erosions, suggestive of spondylodiscitis. Chest CT demonstrated bilateral upper-lobe nodular infiltrates that later evolved with cavitations. Without clinical improvement after antibiotics for common bacterial etiologies, preemptive anti-tuberculosis therapy was initiated, reinforced by a positive urinary TB antigen lateral flow test (LF-LAM) from an isolated urine sample. Paravertebral drainage by interventional radiology did not yield culture confirmation. Sputum AFB smear and Xpert MTB/RIF were negative. After treatment initiation, the patient improved clinically and laboratorially; however, subsequent CT revealed a fistulous tract between the mid-esophagus and posterior mediastinum with a mediastinal collection. Aspiration and drainage were performed, and molecular testing on the sample showed “trace” positivity for TB (“Xpert MTB/RIF trace”). With continued treatment and an alternative feeding route, the patient maintained progressive clinical and radiological improvement. This report describes an atypical presentation in an immunocompetent individual and a rare complication with few cases described in the literature. TB diagnosis and control remain challenging; in this context, LF-LAM, although not yet validated for this population, helped guide diagnosis and appropriate treatment.