Convergence of Rare Complications: Tracheoesophageal, Esophagomediastinal, and Bronchomediastinal Fistulas and Broncholith with Human Immunodeficiency Virus–Tuberculosis Coinfection: A Case Report

After rigorous literature search, we conclude that this is the first global case reported of a patient presenting with tracheoesophageal, esophagomediastinal, pneumomediastinum, and bronchomediastinal fistula and broncholith; esophageal candidiasis, esophageal ulcer, and gastric body and antral erosion due to human immunodeficiency virus (HIV) and tuberculosis (TB) coinfection.Pulmonary TB caused by Mycobacterium tuberculosis (MTB) has been known to humankind over centuries; however, it still remains an important global concern.A 24-year-old man with no known comorbidities presented with fever, cough, and hemoptysis for 20 days.Radiological examination (computed tomography) revealed bilateral nodular infiltrates, mediastinal lymphadenopathies, and bronchomediastinal fistula.Bronchoscopy showed bronchomediastinal fistula originating from the right intermediate bronchus with broncholith.Bronchial wash examination was done, and GeneXpert detected MTB without rifampicin resistance.Human immunodeficiency virus infection was found to be positive with high viral load (939445 copies/mL) and absolute CD4 count of 13 cells/L.Upper gastrointestinal endoscopy showed esophagomediastinal fistula and esophageal candidiasis.He was started on antituberculosis treatment (ATT) with isoniazid, rifampicin, pyrazinamide, and ethambutol after 4 weeks of antiretroviral therapy.On further follow-up, 2 months after staring ATT, he improved clinically and also showed radiological improvement.We report this as a novel case report, as this patient presented with tracheoesophageal fistula, bronchomediastinal fistula, broncholith, pneumomediastinum pulmonary nodules, mediastinal lymphadenopathy, esophageal candidiasis, esophageal ulcer, and gastric body antral erosion, and all of these improved with pharmacological treatment with ATT without any therapeutic bronchoscopic, endoscopic, or surgical interventions.