Treatment of a broncho-esophageal fistula complicated by severe ARDS

Introduction Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients. Methods and Results In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated...

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Bibliographic Details
Published in:Infection 2019-06, Vol.47 (3), p.483-487
Main Authors: Tautz, E., Wagner, D., Wiesemann, S., Jonaszik, A., Bode, C., Wengenmayer, T., Staudacher, D., Biever, P., Hoeppner, J., Duerschmied, D.
Format: Article
Language:English
Subjects:
Antibiotics
Case Report
Esophagus
Family Medicine
Fistula
Fistulae
General Practice
Immunocompromised hosts
Implantation
Implants
Infectious Diseases
Internal Medicine
Lungs
Mediastinitis
Medicine
Medicine & Public Health
Muscles
Oxygenation
Patients
Respiratory distress syndrome
Respiratory therapy
Surgical implants
Therapy
Tuberculosis
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Summary:Introduction Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients. Methods and Results In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated by extensive osseous involvement and a broncho-esophageal fistula with consecutive aspiration of gastric contents. The patient rapidly developed a severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (ECMO) therapy for nearly 2 months. The fistula was initially treated by standard antituberculous combination therapy and implantation of an esophageal and a bronchial stent. Long-term antibiotic treatment was instituted for pneumonia and mediastinitis. 7 months later, discontinuity resection of the esophagus was performed and the bronchial fistula covered by an intercostal muscle flap. Discussion This case illustrates that tuberculosis should always be suspected in patients from high-incidence countries in case of lung involvement and that an interdisciplinary approach including long-term intensive care management can enable successful treatment of tuberculosis with severe, near-fatal complications.
ISSN:0300-8126
1439-0973
DOI:10.1007/s15010-018-1247-9