Case 4:
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A 28 year old male presented with the chief complaints of dysphagia and loss of weight since 3 months. Lab parameters showed a high ESR and white cell count, and positive HIV. X-ray chest showed superior mediastinal widening. A barium swallow was performed.
What is your diagnosis ?


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Tracheo-oesophageal fistula secondary to caseating tuberculous lymphadenopathy

Although atypical mycobacterial infections occur in 10% of patients with AIDS, the incidence of mycobacterium tuberculosis (TB) is rising, TB tends to occur early in the course of AIDS, before the immuno-defeciency has fully developed. The clustering of TB infections around the time of AIDS diagnosis suggests that most infections are due to reactivation of previously latent infections rather than de novo infection.
The manifestation of TB infections in patients with AIDS is frequently atypical; extra pulmonary infection and non-cavitatory non-apical pulmonary diseases are common, and often the disease becomes widely disseminated.

Contribution : Dr Harsh Merchant, Mumbai, India

1. Goldman KP. AIDS and tuberculosis. Br Med J 1987; 295; 511-12.
2. Craze CMAJ, Grundy A. Case report: tuberculous broncho-oesophageal fistula in the Acquired Immunodefeciency Syndrome. Clin Radiol 1991l 43: 60-62.