title: [A case of esophageal and intestinal tuberculosis that occurred during treatment of rheumatoid arthritis with etanercept].
abstract: An 88-year-old woman with rheumatoid arthritis who had started etanercept treatment in July 2011 was referred to our hospital in February 2012 for right-sided pleural effusion. Chest computed tomography showed right pleural effusion, partial swelling of a calcified mediastinal lymph node, and mid-esophageal thickening of the mucosal wall. Gastroendoscopy showed mid-esophageal ulceration. Histological examination of biopsy specimens from this ulceration revealed noncaseating granulomas with Langhans giant cells. Ziehl-Neelsen staining of this section was positive for acid-fast bacilli. Polymerase chain reaction analysis of gastric juice was positive for Mycobacterium tuberculosis; we therefore diagnosed the patient with esophageal tuberculosis. However, since abdominal computed tomography showed swelling of mesenteric lymph nodes, we also suspected intestinal tuberculosis. Colonoscopy showed multiple ileal erosions; histological analyses of biopsied specimens revealed granulomas with Langhans giant cells, similar to the esophageal findings. We finally diagnosed the patient with both esophageal and intestinal tuberculosis. After anti-tuberculosis treatment, the right pleural effusion disappeared and the abdominal lesions improved. Although mycobacterial involvement of both the esophagus and intestine is rare in immunocompromised and immunocompetent hosts, differential diagnosis of these diseases is likely to become more important.
authors.forename: Rie
authors.initials: R
authors.lastname: Anazawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Suzuki
authors.forename: Hideki
authors.initials: H
authors.lastname: Miwa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tomita
authors.forename: Hidenori
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004935:Esophageal Diseases / Q000209:etiology*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D018124:Receptors, Tumor Necrosis Factor; D014385:Tuberculosis, Gastrointestinal / Q000209:etiology*
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept