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Case report
Acquired tracheoesophageal fistula in disseminated Mycobacterium avium complex associated with anti-interferon-gamma autoantibodies
  1. Ibrahim Yaghnam1,
  2. Rohit Jain2,
  3. Rashma Golamari2 and
  4. Kofi Clarke3
  1. 1Internal Medicine, Penn State Health Milton S. Hershey Medical Center Department of Medicine, Hershey, Pennsylvania, USA
  2. 2Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
  3. 3Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Ibrahim Yaghnam; iyaghnam{at}pennstatehealth.psu.edu

Abstract

We describe a case of a 30-year-old previously healthy woman who presented to our hospital with a 2-month history of fevers, tender lymphadenopathy, dysphagia, globus sensation and occasional haematemesis. Further evaluation revealed cervicothoracic adenopathy and a subcarinal mass with oesophageal involvement. Imaging showed a transesophageal fistula at the level of the carina with contrast extravasation to the left main bronchus. Our patient was diagnosed with disseminated Mycobacterium avium complex (MAC) based on acid-fast bacillus noted on sputum cultures and nodal biopsies. Further investigation revealed anti-interferon-gamma autoantibodies as a possible predisposing factor for the disseminated MAC infection. This case demonstrates the importance of a broad differential diagnoses in a patient presenting with unexplained cervicothoracic lymphadenopathy, fever and dysphagia. Although acquired tracheoesophageal fistulae are uncommon, it should be considered in the clinical setting of globus sensation, haemoptysis and dysphagia. Furthermore, our case highlights a rare predisposition to disseminated Mycobacterium infection.

  • GI-stents
  • immunology
  • infectious diseases
  • genetics
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Footnotes

  • Contributors IY: As the corresponding author, I was one of the primary physicians who cared for this patient and I obtained consent from the patient prior to submitting this article. I conducted the literature review for this case. I wrote the case, edited, selected the appropriate clinical images and discussed the case at length with the senior author KC as well as with RJ and RG. RJ: Provided feedback, coauthored the case report and made edits/revisions prior to submission. Assisted with literature review. RG: Provided edits and reviewed the case regularly prior to final submission. KC: Acted as our senior gastroenterology consultant, also directly cared for this patient. He provided detailed feedback and edits, as well as overall supervision of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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