[A case of miliary tuberculosis and esophageal perforation secondary to tuberculous mediastinal lymphadenitis].
An 80-year-old woman was admitted to a local hospital following transient disturbance of consciousness after a fall. High intermittent fever developed after hospitalization and she was diagnosed as having mediastinal abscess with esophageal perforation. She underwent mediastinal drainage and surgical repair of the esophagus. Acid-fast bacilli were detected in her sputum. Chest CT scanning showed a diffuse granular shadow. Then she was diagnosed as having miliary tuberculosis and treated with combination of INH, RFP, EB, and PZA. However, five days after treatment was initiated, fever and skin eruption appeared and treatment has to be stopped after one month. Then she was referred to our hospital. We gradually increased the dosages of INH and RFP, which resulted in pyrexia. Therefore, we changed EB to SM. Fever subsided and we were able to administer the full dose of drugs from the beginning of January 2007. Thereafter, the patient improved gradually. However, she died in February 2007. At autopsy, we identified tuberculous mediastinal lymphadenitis, inflammatory granuloma under the esophageal mucosa and miliary tuberculosis. We report this case as a rare case of miliary tuberculosis and esophageal perforation secondary to tuberculous mediastinal lymphadenitis.
Ishikawa
Shigenori
S
Department of Pulmonary Medicine, National Hospital Organization Matsue National Hospital, 5-8-31, Agenogi, Matsue-shi, Shimane 690-8556 Japan. ishi-kma@matsue.hosp.go.jp
Yano
Shuichi
S
Wakabayashi
Kiryo
K
Kadowaki
Toru
T
Kimura
Masahiro
M
Kobayashi
Kanako
K
Ikeda
Toshikazu
T
Takeyama
Hiroyasu
H
D000369:Aged, 80 and over; D004939:Esophageal Perforation / Q000209:etiology*; D005260:Female; D006801:Humans; D008477:Mediastinal Diseases / Q000150:complications*; D014388:Tuberculosis, Lymph Node / Q000150:complications*; D014391:Tuberculosis, Miliary / Q000150:complications*