title: Intestinal Tuberculosis with Hoarseness as a Chief Complaint due to Mediastinal Lymphadenitis.
abstract: A 68-year-old woman was admitted to our hospital complaining of hoarseness. A chest X-ray detected an abnormal shadow on the upper right lung. Bronchoscopic examination revealed that the left vocal cord was fixed in the paramedian position, and therefore left recurrent nerve paralysis was suspected. Lymphadenopathy was found in the left supraclavicular area. Chest computed tomography showed that the pretracheal and subaortic lymph nodes were swollen. Gastroendoscopy showed a 2-cm protruding lesion with ulceration on the upper esophagus. Histological examination of the supraclavicular lymph nodes and biopsy specimens from the esophagus revealed non-specific inflammation. PET-CT showed abnormal accumulations not only on the upper right lung but also on the lower right of the abdomen. Colonoscopy was performed and multiple erosions on the terminal ileum were found. Polymerase chain reaction analysis of a specimen biopsied from the erosion of the terminal ileum was positive for Mycobacterium tuberculosis and intestinal tuberculosis was diagnosed. The patient was then treated with anti-tuberculous therapy. After treatment, the erosions on the terminal ileum, the swelling of the mediastinal lymphadenopathy, and the esophageal ulcer were all improved. The hoarseness was subsequently relieved. This is the first report of intestinal tuberculosis with hoarseness as a chief complaint due to mediastinal lymphadenitis.
authors.affiliation: Departments of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Nagai
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ueno
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hayashi
authors.forename: Toshiko
authors.initials: T
authors.lastname: Onitake
authors.forename: Rie
authors.initials: R
authors.lastname: Hanaoka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Wada
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
references.citation: Am J Gastroenterol. 1993 Jul;88(7):989-99
references.pmid: 8317433
references.citation: Gastrointest Endosc. 2004 Mar;59(3):362-8
references.pmid: 14997132
references.citation: Surg Infect (Larchmt). 2008 Jun;9(3):407-10
references.pmid: 18570584
references.citation: J Gastroenterol Hepatol. 2009 Nov;24(11):1798-9
references.pmid: 20136962
references.citation: Radiology. 1990 May;175(2):449-53
references.pmid: 2326472
references.citation: Tuber Lung Dis. 1992 Jun;73(3):174-6
references.pmid: 1421352
references.citation: Gut. 1992 Mar;33(3):347-51
references.pmid: 1568653
references.citation: Int J Colorectal Dis. 2009 Oct;24(10):1175-80
references.pmid: 19421759
references.citation: J Gastroenterol Hepatol. 1999 Jul;14(7):723-9
references.pmid: 10440219
references.citation: Postgrad Med J. 1992 Feb;68(796):110-5
references.pmid: 1570250
references.citation: Arch Pathol Lab Med. 2003 Mar;127(3):326-30
references.pmid: 12653577
references.citation: Ann Intern Med. 1959 Nov;51:897-932
references.pmid: 14419189