title: [Ulcerating tumor of the esophagus as a primary manifestation of extrapulmonary tuberculosis].
abstract: METHODS
  The patient, a 36-year-old man from Somalia, who had moved to Germany a year before, was referred for a diagnostic work-up of an ulcerating tumour. He suffered from thoracic tightness for the last weeks albeit without any further symptoms. There were no pre-existing illnesses. No further pathological signs were found during a preliminary physical examination.
  
  
  METHODS
  After ruling out any malignancies by means of an analysis of biopsy samples, further differential diagnostic measures were undertaken. Besides mechanical and chemical factors, an infectious genesis of the esophageal lesion was considered and investigated further through histological, immunohistochemical, laboratory and microbiological tests.
  
  
  METHODS
  Mycobacterium tuberculosis was detected in cultures sampled from biopsy material. This strain turned out to be responsive to medical treatment. Further diagnostics regarding a potential primary pulmonary tuberculosis were negative. Histological analysis of a liver biopsy confirmed noncaseating epithelioid cellular granuloma as typically seen in granulomatous hepatitis without any direct evidence of mycobacteria. Thus, tuberculosis of the liver appeared most likely considering the differential diagnosis of a granulomatous hepatitis. The patient underwent standard treatment using antituberculous drugs over six months. Endoscopic control after two months showed a significant reduction of the ulcerating lesion.
  
  
  CONCLUSIONS
  Ulcerating tumors of the esophagus are primarily classified as potential malignancies. Crohn's disease is an important differential diagnosis. Apart from mechanical and chemical causes, infectious diseases should be taken into consideration. However, tuberculosis is one of the most relevant differential diagnoses, particularly in patients immigrating from TB-prone countries, pre-existing immune deficiency or environmentally induced elevated infection risk.
authors.affiliation: Innere Medizin - Gastroenterologie, Krankenhaus Grafenau.
authors.forename: J
authors.initials: J
authors.lastname: Rügamer
authors.forename: R
authors.initials: R
authors.lastname: Kaaden
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D005773:Gastroscopy; D005858:Germany; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012998:Somalia / Q000208:ethnology; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D014386:Tuberculosis, Hepatic / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D014456:Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology
chemical_list: D000995:Antitubercular Agents