TUBERCULOSIS AS A MISDIAGNOSIS OF UNDIAGNOSED ACHALASIA A CASE REPORT
Imam Syakhruddin,Nasichatun Nisak,Ninung Rose Diana Kusumawati
Department of Pediatric Faculty of Medicine Diponegoro University Dr Kariadi Hospital Semarang
Background : Achalasia is a rare esophageal motility disorder in children, characterized by failure of lower esophageal sphincter relaxation. Vomiting and aspiration pneumonia as the most common manifestations might not have led to achalasia diagnosis. The prevalence of achalasia is higher in individuals with Down Syndrome (DS). We reported a case of DS with achalasia initially diagnosed as suspected multidrugs resistence tuberculosis (MDR TB).
Case Presentation Summary : A 5-year-old girl was referred to Kariadi Hospital with recurrent pneumonia and suspected MDR TB. The patient received 9-months tuberculosis treatment for four times from different physicians; and admitted nine times to hospital due to recurrent pneumonia. Since she was 2 months old, the girl had recurrent vomiting, cough with occasional dyspnea, fever and weight loss. In our hospital, physical examination revealed dysmorphic facial features, malnourished and anemic, fever, dyspnea, ronchi and crackles on bilateral lung. The chest x-ray revealed impression of an bronchopneumonia and left upper lobe atelectasis. Xpert MTB showed a negative result, meanwhile sputum culture yielded Klebsiella pneumonia growth. She was consulted to gastrohepatology division due to her chronic vomiting symptom. Barium swallow examination showed bird’s beak appearance, suspect achalasia. The esophageal manometric study was not performed due to technical difficulty. She was diagnosed as achalasia with aspiration pneumonia as a complication. She received antibiotic and underwent pneumatic balloon dilatation. After 9-months evaluation, there had been no vomiting or pneumonia and she developed remarkable catch-up growth.
Learning Points/Discussion : It was essential for physicians to recognize an achalasia symptoms in early step to prevent further complication