[Esophagomediastinal fistulae as a rare complication of tuberculosis in an HIV-infected patient].
A 57-year-old man with an HIV infection, diagnosed a year ago, complained of fever and cough. The haemoglobin level was 7.5 g/dl, white cell count 3800/microliters, T-helper cell count 60/microliters and the CD4-CD8 ratio 0.1. Erythrocyte sedimentation rate was raised to 21/39 mm. Bacteriological tests were at first negative. The chest radiograph showed slight widening of the upper mediastinum which further increased over the next 10 days, at which time it also revealed a shadow in the right upper lobe. Computed tomography suggested necrotizing mediastinal lymph-nodes. Treatment was begun with rifampicin (600 mg daily) ethambutol (1.2 g daily), pyrazinamide (1.5 g daily) and ciprofloxacin (500 mg twice daily). Oesophagoduodenoscopy, performed after 3 weeks, revealed several fistulae which, after ingestion of contrast medium, were demonstrated to communicate with the mediastinum, presumably as a result of lymph-node liquefaction. Mycobacterium tuberculosis was demonstrated in gastric juice, sputum and stool only after tuberculostatic drugs had been started.
Greten
T
T
Medizinische Klinik, Klinikum Innenstadt, Universität München.
Hautmann
H
H
Trauner
A
A
Huber
R M
RM
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002939:Ciprofloxacin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004937:Esophageal Fistula / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004977:Ethambutol / Q000008:administration & dosage; D005402:Fistula / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D011718:Pyrazinamide / Q000008:administration & dosage; D012293:Rifampin / Q000008:administration & dosage; D014388:Tuberculosis, Lymph Node / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D011718:Pyrazinamide; D002939:Ciprofloxacin; D004977:Ethambutol; D012293:Rifampin
Osophago-mediastinale Fisteln als seltene Komplikation der Tuberkulose bei einem HIV-infizierten Patienten.