Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Bronchoesophageal fistula in a patient with Crohn's disease receiving anti-tumor necrosis factor therapy

  • Kyunghwan Oh (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kee Don Choi (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyeong Ryul Kim (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Tae Sun Shim (Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Byong Duk Ye (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Suk-Kyun Yang (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Hyoung Park (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2021.08.04
  • Accepted : 2021.09.09
  • Published : 2023.03.30
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Abstract

Tuberculosis is an adverse event in patients with Crohn's disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn's disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient's condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

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References

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