[A 27-year-old patient with recurrent Fever].
BACKGROUND
In spite of a decreasing incidence of tuberculosis in highly industrialized countries, an obvious increase of the disease is observed worldwide. In times of progressing international migration, the early detection of tuberculosis is also becoming important in Germany. The diagnosis, however, is often impaired by unspecific symptomatology and ambiguous imaging results.


METHODS
A 27-year-old patient from Iraq presented with unclear recurring and antibiotic-resistant fever and inconspicuous thoracic X-ray. Only by thoracic computed tomography, markedly necrotizing mediastinal lymph nodes could be detected. Following lymph node biopsy and histologic investigation, the diagnosis of mediastinal lymph node tuberculosis could be ascertained. Test-adjusted antituberculotic combination treatment resulted in a normalization of body temperature and cessation of complaints. Starting from the case report presented, the importance of various investigative methods for the quick and secure diagnosis of tuberculosis and subsequent therapy are discussed.


CONCLUSIONS
Unclear febrile disease even in young patients with an inconspicuous conventional thoracic X-ray may be caused by tuberculosis. In this situation, early extension of imaging diagnostics appears to be advantageous.
Denk
Gerald Ulrich
GU
Medizinische Klinik II der Ludwig-Maximilians-Universität München-Grosshadern, München-Grosshadern.
Bergstermann
Karl-Heinz
KH
Gallmeier
Eike
E
Schirra
Jörg
J
Wagner
Hubert
H
Göke
Burkhard
B
Lamerz
Rolf
R
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D005334:Fever / Q000209:etiology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008481:Mediastinoscopy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D013902:Radiography, Thoracic; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin