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Tracheoesophageal fistula in a case of Pott’s spine: Unusual presentation amid COVID pandemic

Acquired tracheoesophageal fistula (TOF) is a rare entity. We present a case of a 49-year male, non-smoker, with no known comorbidities admitted with acute respiratory symptoms and desaturation to a COVID hospital during the first peak of the pandemic. Initial workup showed all raised inflammatory markers, deranged liver function, and poor ejection fraction of 20%. COVID RT-PCR was negative. Early high-resolution computed tomography done as COVID suspect, peaked up the tracheoesophageal fistula with aspiration pneumonia. On magnetic resonance imaging spine, paradiscal, prevertebral involvement at the D1-D2 level suggesting Pott’s spine, with mediastinal irregular cavity formation, ruptured in trachea and esophagus. A detailed history revealed neck pain for 3 months and increased cough while swallowing for 10 days. Neck pain was not evaluated due to fear of COVID and lockdown. On esophagoscopy, anterior wall of the upper esophagus had fistula with smooth clear margins. Diagnosis of tubercular TOF confirmed on endotracheal inflamed fistulous track secretions. The patient was treated conservatively with initial nasogastric tube feeding and antitubercular treatment achieving complete resolution.