title: [Dysphagia in a young woman from Somalia].
abstract: BACKGROUND
  Multidrug-resistant tuberculosis is increasing worldwide. The determination of possible resistance is essential for adequate treatment. Tuberculosis is common amongst immigrants from Somalia and extra-pulmonary localisation is often seen.
  
  
  METHODS
  A 21-year-old woman from Somalia presented with progressive dysphagia and severe weight loss. Endoscopy revealed two ulcers in the mid-oesophagus. A chest x-ray showed enlarged lymph nodes in the right hilar and mediastinal regions. The Ziehl-Neelsen stain and PCR for mycobacteria were negative. Sputum samples and oesophageal biopsies were cultured. Quadruple tuberculostatic therapy was started empirically. After five weeks, a sputum culture grew Mycobacterium tuberculosis, which was resistant to rifampicin and isoniazid. She was treated with second-line anti-tuberculous therapy and eventually recovered.
  
  
  CONCLUSIONS
  Tuberculosis can manifest in many ways. It is important to obtain patient material for culture; not only to confirm the diagnosis but also for the determination of possible resistance which is necessary for adequate therapy.
authors.affiliation: Academisch Medisch Centrum, Amsterdam.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Veldhuis
authors.forename: Richard
authors.initials: R
authors.lastname: van Altena
authors.forename: Reindert P
authors.initials: RP
authors.lastname: van Steenwijk
authors.forename: Erik A J
authors.initials: EA
authors.lastname: Rauws
authors.forename: Jan Karel M
authors.initials: JK
authors.lastname: Eeftinck Schattenkerk
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D009426:Netherlands; D012293:Rifampin / Q000494:pharmacology; D012998:Somalia / Q000208:ethnology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin