title: [A case of tuberculosis with multiple lung nodules, abdominal lymphadenopathy, and splenomegaly].
abstract: Abdominal tuberculous lymphadenitis is very rare. We report a case of pulmonary tuberculosis showing marked abdominal lymphadenopathy and splenomegaly. A 95-year-old man was admitted to our hospital because of abnormal chest X-ray and body weight loss in last 6 months. He had low grade fever with no abdominal pain. He did not have past history of tuberculosis. Laboratory examination showed mild renal dysfunction and mild glucose intolerance. Soluble interleukin 2 recepter was highly elevated (3800 U/ml). Tumor markers, such as carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA), and progastrin-releasing peptide (Pro GRP) were all within normal limit. Chest X-ray showed multiple nodules in bilateral lung fields. Chest computed tomography showed multiple nodules in bilateral lungs, especially in upper part of lungs, right hilar lymphadenopathy and upper mediastinal lymphadenopathy. Abdominal and pelvic enhanced computed tomography showed marked abdominal lymphadenopathy and splenomegaly (67 x 49 mm). Abdominal lymph nodes were hepatoduodenal (50 x 50 mm), splenic hilar (40 x 25 mm), upper paraaortic (30 x 60 mm), and small superior mesenteric (10 x 10 mm) lymph nodes. FDG-PET showed accumulation in the nodules of right lung field, right hilar lymph nodes, upper mediastinal lymph nodes, and abdominal lymph nodes. Bronchial lavage fluid (BAL) smear for acid-fast bacilli was positive, polymerase chain reaction for Mycobacterium tuberculosis was positive and acid-fast bacilli was cultured. Transbronchial lung biopsy specimen demonstrated non-specific intraalveolar organization and alveolitis. The patient was diagnosed as pulmonary tuberculosis, but about abdominal lymphadenopathy and splenomegaly we had to differentiate malignant lymphoma, and for definite diagnosis, laparotomy was necessary. But considering his age and general condition, we followed up carefully with anti-tuberculosis therapy. Pulmonary tuberculosis, abdominal lymphadenopathy and splenomegaly all showed marked improvement 4 months after starting anti-tuberculosis therapy with isoniazid, rifampicin, and ethambutol, so we clinically diagnosed abdominal tuberculous lymphadenitis and splenic tuberculosis.
authors.affiliation: Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Japan. mhorie-tky@umin.ac.jp
authors.forename: Masafumi
authors.initials: M
authors.lastname: Horie
authors.forename: Megumi
authors.initials: M
authors.lastname: Tarui
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Kashizaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawashima
authors.forename: Junko
authors.initials: J
authors.lastname: Suzuki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shimada
authors.forename: Kousuke
authors.initials: K
authors.lastname: Araki
authors.forename: Kousaku
authors.initials: K
authors.lastname: Komiya
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Matsui
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Ohshima
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Masuda
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Tamura
authors.forename: Naohiro
authors.initials: N
authors.lastname: Nagayama
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyoda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.forename: Shinobu
authors.initials: S
authors.lastname: Akagawa
authors.forename: Yutsuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*; D014400:Tuberculosis, Splenic / Q000175:diagnosis*