Esophageal perforation and pneumomediastinum: Rare complications of tuberculosis

A 54-year-old HIV-positive African American man was diagnosed with esophageal tuberculosis. His condition was complicated by esophageal perforation and pneumomediastinum. When treated with isoniazid, rifampin, ethambutol, and pyrazinamide, he developed medication-induced hepatitis. Streptomycin and levofloxacin were used as alternative agents along with isoniazid and ethambutol, which were tolerated well. At the end of 2 months, there was clinical improvement and resolution of pneumomediastinum. Surgery was not required. This is the first report of successful treatment of tuberculosis-related esophageal perforation and pneumomediastinum using second-line antituberculous agents.