A patient with esophageal tuberculosis who died of massive hematemesis is described. The origin of the disease was probably pulmonary and the esophageal affliction could have been produced by both the ingestion of contaminated sputum or direct extension from mediastinal lymphatic nodes. The diagnosis was reached by the discovery of caseation granulomas at esophagoscopy and the isolation of Mycobacterium Tuberculosis in the sputum. We comment on the rareness of the disease, clinical and endoscopic features which can resemble a neoplasia. At the same time, we highlight the possibility of serious complications, mainly upper gastrointestinal hemorrhage which is potentially lethal, and the aorto-esophageal communication, thus early diagnosis and surgical treatment being most important.