A Case Report of Achalasia in HIV-Tuberculosis Co-Infected Adolescent

Aims: To sensitize clinicians on the need to consider achalasia in HIV infected children presenting with dysphagia.

Presentation of Case: A 14-year-old HIV-infected boy presented with 4years of difficulty and painful swallowing. It was initially to solid food and progressed to liquid diet and water. There were associated intermittent vomiting, weight loss, and recurrent fever. Examination revealed a stunted and chronically ill-looking boy, weighed 22.5Kg and measured 139cm in height, 48.3% and 86.3% of the expected for age respectively. He had generalized lymphadenopathy and whitish patches on the tongue. Initial differential diagnoses were oesophageal candidiasis and achalasia with pulmonary tuberculosis. Chest X-ray and stool gene Xpert confirmed Mycobacterium tuberculosis. The cluster of differentiation (CD) 4 count was 380 cells/ml. He had anti-Koch’s drugs and oral fluconazole for 6 months and 8 weeks respectively, and later highly active antiretroviral therapy. Despite the completion of the fluconazole, the presented symptoms got worsened and the patient could not even take his medications, and his weight dropped to 15kg. Barium swallow and upper GI endoscopy done later confirmed achalasia. He had a successfully modified Heller’s myotomy procedure after which he could eat, drink and take his medications. He was discharged and kept his regular clinic appointments with appreciable weight gain.

Conclusion: Achalasia could occur in HIV-infected children when presented with dysphagia and therefore, a high index of suspicion is needed to make a timely diagnosis to avoid complications and death.