Tracheoesophageal Fistula as a Rare Cause of Persistent Pulmonary Tuberculosis Symptoms

Tracheoesophageal fistula (TEF) is a rare yet severe complication of tuberculosis (TB), often leading to persistent symptoms, recurrent infections, and treatment failure. Its early recognition and appropriate management are crucial to improving patient outcomes. We report the case of a 24-year-old woman with pulmonary TB who presented with persistent fever, copious expectoration, and progressive weight loss despite receiving anti-tubercular therapy (ATT) for 3 months. She developed a right pneumothorax, requiring Malecot catheter insertion, and was referred to our institute due to poor treatment response. Differential diagnoses, including drug-resistant TB and malabsorption, were ruled out. Clinical suspicion of TEF arose due to worsening cough on swallowing. Bronchoscopy confirmed a TEF, five tracheal rings above the carina, measuring 7-8 mm in diameter. A computed tomography scan delineated its extent, and bronchoalveolar lavage analysis confirmed Mycobacterium TB. The patient was managed with nasogastric feeding, intravenous antibiotics, and ATT continuation. Her condition improved significantly within 10 days. TEF is a rare but serious complication of pulmonary TB that can significantly impact treatment success. Early recognition, nutritional support, and ATT continuation are crucial for improved outcomes and preventing complications this case underscores the importance of considering TEF in patients with persistent symptoms despite standard TB treatment.