Plummer–Vinson Syndrome in a Young Male with Coexisting Pulmonary Tuberculosis Presenting as Severe Refractory Anemia and Dysphagia: A Rare Case Report

Abstract

Plummer–Vinson syndrome (PVS) is a rare clinical condition characterized by the triad of iron deficiency anemia (IDA), dysphagia, and upper esophageal web. It predominantly affects middle-aged females and is uncommon in young males. We report the case of a 24-year-old male patient presenting with complaints of gradually progressive dysphagia and recurrent severe anemia, which required multiple blood transfusions. Clinical examination revealed pallor, angular cheilitis, and glossitis. Laboratory investigations showed severe microcytic hypochromic anemia with reduced serum ferritin and iron levels, suggesting IDA with an inflammatory component. Radiological testing, including contrast-enhanced computed tomography and barium swallow, identified an upper esophageal web. Upper gastrointestinal endoscopy confirmed cervical esophageal narrowing, which was successfully treated with Savary–Gilliard bougie dilatation. Further evaluation revealed pulmonary tuberculosis (TB) with bronchoalveolar lavage positive for Mycobacterium tuberculosis on cartridge-based nucleic acid amplification test. The patient was managed with endoscopic dilatation, oral iron supplementation, and antitubercular therapy, resulting in complete resolution of dysphagia and significant hematologic improvement on follow-up. This case highlights the importance of diagnosing PVS and evaluating for the cause of anemia rather than treating the patient symptomatically and considering pulmonary TB as a diagnosis in patients who present with atypical complaints and emphasizes its role as a chronic inflammatory disease in aggravating iron deficiency and anemia of chronic disease. Early recognition and prompt multidisciplinary management are essential to prevent diagnostic delay, alleviate symptoms, and improve outcome.