Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor.
- Author:
Dongwuk KIM
1
;
Juwon KIM
;
Daegeun LEE
;
Ha Sung CHANG
;
Hyunsung JOH
;
Won Jung KOH
;
Jun Haeng LEE
Author Information
- Publication Type:Case Report
- Keywords: Tuberculosis; Lymphadenitis; Esophageal fistula
- MeSH: Biopsy; Endoscopy, Digestive System; Esophageal Fistula; Ethambutol; Female; Fistula*; Humans; Inflammation; Isoniazid; Lymph Nodes; Lymphadenitis*; Lymphatic Diseases; Middle Aged; Pyrazinamide; Rifampin; Thorax; Tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Multidrug-Resistant; Ulcer
- From:Clinical Endoscopy 2016;49(6):564-569
- CountryRepublic of Korea
- Language:English
- Abstract: Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.
