title: [Case of miliary tuberculosis with esophageal perforation and a tracheal inflammatory polyp secondary to mediastinal lymphadenitis causing massive hematemesis and hemosputum].
abstract: A 62-year-old man with a history of left nephrectomy due to tuberculosis was referred to our hospital, because chest radiography showed diffuse miliary shadows in the bilateral lung fields, and acid-fast bacilli were detected from his hemosputum after steroid therapy for fever of unknown origin. Chest computed tomography showed mediastinal lymph node enlargement with partial calcification of these lymph nodes together with the presence of air. He was diagnosed with miliary tuberculosis and tuberculous mediastinal lymphadenitis and anti-tuberculosis drug therapy was started. Massive hematemesis occurred 11 days after the start of the treatment. Although gastroendoscopy was performed, the bleeding point could not be identified. The patient's symptoms improved after conservative therapy. Repeat gastroendoscopy showed a submucosal nodule with laceration of the esophageal mucosa, 30 days after admission for the examination of melena and progression of anemia. The episodes occurred because of esophageal perforation secondary to tuberculous mediastinal lymphadenitis. Bronchoscopic examination for hemosputum showed an inflammatory polypoid lesion in the left tracheal wall. These symptoms improved with anti-tuberculosis drug therapy. In our case, mediastinal lymphadenitis progressed to miliary tuberculosis because of endogenous reactivation. We report a rare case of esophageal perforation with a tracheal inflammatory polyp secondary to tuberculous mediastinal lymphadenitis. In cases of tuberculous mediastinal lymphadenitis, if hematemesis or hemosputum is observed, an endoscopic examination should be performed.
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Shiga National Hospital, 255 Gochi-cho, Higashioumi-shi, Shiga 527-8505 Japan. ohuchi-masatsugu@shiga-hosp.jp
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ohuchi
authors.forename: Shuhei
authors.initials: S
authors.lastname: Inoue
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Takuya
authors.initials: T
authors.lastname: Fujita
authors.forename: Jun
authors.initials: J
authors.lastname: Hanaoka
mesh_terms: D001999:Bronchoscopy; D016099:Endoscopy, Gastrointestinal; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology*; D006396:Hematemesis / Q000209:etiology*; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000209:etiology*; D013183:Sputum; D014057:Tomography, X-Ray Computed; D014134:Tracheal Neoplasms / Q000175:diagnosis / Q000209:etiology*; D014388:Tuberculosis, Lymph Node / Q000150:complications* / Q000175:diagnosis; D014391:Tuberculosis, Miliary / Q000175:diagnosis / Q000209:etiology*