Mediastinal tuberculous lymphadenitis causing a broncho-mediastinal-oesophageal fistula.

Mediastinal tuberculous lymphadenitis and tuberculous fistulae are recognised complications of pulmonary tuberculosis (TB); however, we could find no documented cases of broncho-mediastinal-oesophageal fistulae.We describe the case of a patient in their early 20s from a South Asian country with endemic TB who presented to a UK hospital with a productive cough, fevers, reduced appetite, inter-scapular pain and feeling generally unwell. They were initially diagnosed with community-acquired pneumonia but their symptoms were refractory to antibiotic therapy. Following CT and endoscopy with biopsies, they were diagnosed with TB with a complex broncho-mediastinal-oesophageal fistula secondary to mediastinal tuberculous lymphadenitis.They were treated with anti-TB therapy and resumed on oral intake 201 days after initial admission. A multidisciplinary approach was required to address multiple medical and surgical issues, including nutrition and delivery of anti-TB therapy.