Open AccessAtypical presentation of acquired tracheo-oesophageal fistula in an adolescent girl with pulmonary tuberculosis
Author(s) -
Afreen Khan,
Aparna Chakravarty,
Rizwan Naqishbandi,
Sumbul Qamar
Publication year - 2022
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2021-242384
Subject(s) - medicine , ards , fistula , presentation (obstetrics) , bronchoscopy , respiratory distress , abdominal distension , surgery , tuberculosis , pediatrics , intensive care medicine , lung , pathology
We report a case of an adolescent girl presenting with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Initial presentation during the ongoing COVID-19 pandemic was compatible with multisystem inflammatory response in children associated with COVID-19 (MIS-C). Subsequently a diagnosis of tuberculosis was made. During ventilation, she developed significant abdominal distension which was not relieved with nasogastric decompression. There was a high index of suspicion of bronchoenteric fistula. Bronchoscopy with adjunct oesophagoscopy demonstrated tracheo-oesophageal fistula (TEF). The classical presentation of TEF has been masked by onset of ARDS. During the pandemic the diagnosis of tuberculosis in high-burden countries decreased for multiple reasons leading to development of complications which are often confused with MIS-C. While diagnosing MIS-C, maintaining a high level of suspicion for concomitant or alternative aetiologies is essential.