Late AIDS presentation with tracheoesophageal fistula as an early complication of pulmonary-disseminated tuberculosis – a case report and review of the literature

Background: Tracheoesophageal fistula (TEF) is a complex, challenging condition with a varying degree of acuity, pathogenesis, and therapeutic approaches. TEF is a pathological connection between the trachea and the esophagus that is associated with various underlying conditions. Case Report: A unique report of a TEF of tubercular origin, as a presentation of acquired immunodeficiency syndrome (AIDS) in a young patient with undiagnosed human immunodeficiency virus (HIV) infection, resolved with conservative therapy notwithstanding the extremely severe immunodeficiency and multiple opportunistic infections, is described and commented on the grounds of an updated literature review. Conclusions: There are few reports in the literature of HIV and tuberculosis infection-related TEF and/or bronchoesophageal fistula (BEF). Other reported causes of TEF in AIDS include infections caused by Mycobacterium avium-intracellulare, Candida albicans, Nocardia species, cytomegalovirus and herpes simplex virus. TEF caused by tuberculosis is an exceedingly rare complication and has been postulated to occur secondary to the rupture of caseous peribronchial lymph nodes into adjacent mediastinal structures with subsequent fistula formation. Most patients underwent conservative medical management, as in our case, with parenteral nutrition, with the help of a percutaneous endoscopic gastrostomy (PEG) tube, and parenteral antimycobacterial treatment and antiretroviral therapy (ART) with successful outcomes.