A spontaneous intramural esophagogastric hematoma developed in a patient with hemophilia A. The hematoma did not resolve after antihemophiliac factor replacement but ruptured into the stomach causing massive gastrointestinal bleeding. The associated enlarged right tracheobronchial gland and the histopathological finding of fibrocaseating granuloma at the esophagogastric junction indicated that the primary disorder was esophageal tuberculosis. The whole process responded rapidly to antituberculous treatment.