Korean J Neurogastroenterol Motil.  2009 Dec;15(2):135-140.

Achalasia in a Patient with Disseminated Tuberculosis Tae Jun

• Hwang TJ
• Kim N
• Kim SY
• Kim HH
• Lee BH
• Nam RH
• Lee HE
• Lee DH

Abstract

Achalasia is a well-known esophageal motility disorder characterized by absent primary peristalsis and incomplete relaxation of the lower esophageal sphincter. Idiopathic achalasia is common and could result from infections, intestinal pseudo-obstruction, amyloidosis, surgery, systemic disorders or malignancies. However, achalasia related to Mycobacterium tuberculosis infection has never been reported. We present a case of a 79-year-old woman with achalasia and disseminated tuberculosis initially complaining severe dysphagia and weight reduction of 10 kg over two years. The findings of esophageal manometry and esophagogram were consistent with achalasia. computed tomography (CT) of the abdomen and chest showed a dilated esophagus and multiple nodules in the liver and the spleen as well as lymphadenitis. The result of nested TB PCR of the hepatic nodules was positive. After starting treatment for the tuberculosis, the dysphagia was much improved, suggesting a relation between achalasia and tuberculosis. In addition, the multiple nodules in the liver and spleen with the lymphadenitis on CT improved by the tuberculosis treatment. As the dysphagia of the patient was persistent, laparoscopic myotomy was performed; which was followed by only a small improvement of the dysphagia postsurgically. Dysphagia subsided gradually over 10 months along anti-tuberculosis treatment. In conclusion, this case suggests a possible association between achalasia and M. tuberculosis infection although there was no direct evidence.

Keyword

Achalasia; Mycobacterium Tuberculosis; Laparoscopic myotomy

MeSH Terms

Abdomen
Aged
Amyloidosis
Deglutition Disorders
Esophageal Achalasia
Esophageal Motility Disorders
Esophageal Sphincter, Lower
Esophagus
Female
Humans
Intestinal Pseudo-Obstruction
Liver
Lymphadenitis
Manometry
Mycobacterium tuberculosis
Peristalsis
Polymerase Chain Reaction
Relaxation
Spleen
Thorax
Tuberculosis
Weight Loss