[Non-healing gastric ulcer].
METHODS
A 47-year-old Angolan complained of upper abdominal pain, fever, weight loss and night sweats. Abdominal ultrasound performed by his general practitioner showed enlarged lymph nodes at the liver hilum. Physical examination was negative except for slight tenderness over the right upper abdomen.


METHODS
A tuberculin skin test was clearly positive. Upper gastrointestinal endoscopy revealed multiple gastric ulcers and the Helicobacter pylori test was positive. The lymph nodes at the liver hilum were needle-aspirated, this showed granulomatous inflammation similar to the biopsies of the ulcers. Eradication of Helicobacter pylori and therapy with proton pump inhibitors were initiated.


METHODS
Epigastric pain and the ulcers persisted unchanged. The culture of the lymph node aspirate grew multiresistent Mycobacterium tuberculosis. With adequate tuberculostatic therapy the patient improved rapidly and the further course was without any complications.


CONCLUSIONS
Tuberculosis should be included in the differential diagnosis in non-healing ulcers of the gastrointestinal tract, especially in immigrants from endemic areas.
Gubler
Ch
Ch
Fachbereich Gastroenterologie, Departement Innere Medizin, Kantonsspital St. Gallen.
Ehmann
T
T
Meyenberger
Ch
Ch
D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013272:Stomach Diseases / Q000175:diagnosis* / Q000473:pathology; D013276:Stomach Ulcer / Q000175:diagnosis* / Q000473:pathology; D014374:Tuberculin Test; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000473:pathology; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis / Q000473:pathology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000473:pathology; D014463:Ultrasonography