Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistanttuberculosis (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 tomographyshowed 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 submucosaltumor-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-lineanti-TB medications were prescribed. She recovered well subsequently.
Abstract
Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistanttuberculosis (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 tomographyshowed 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 submucosaltumor-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-lineanti-TB medications were prescribed. She recovered well subsequently.
참고문헌 (16)
- Amorosa JK, "Tuberculous mediastinal lymphadenitis in the adult", Radiology, 126, pp.365~368 (1978)
- Ayed AK, "Diagnosis and treatment of isolated tuberculous mediastinal lymphadenopathy in adults", Eur J Surg, 167, pp.334~338 (2001)
- Shiota Y, "Tuberculous mediastinal lymphadenitis in an adult patient", Jpn J Med, 28, pp.382~384 (1989)
- Ohtake M, "Esophagomediastinal fistula as a complication of tuberculous mediastinal lymphadenitis", Intern Med, 35, pp.984~986 (1996)
- Lin JN, "Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis", Int J Tuberc Lung Dis, 13, pp.620~625 (2009)
- Kim JH, "Achievements in and challenges of tuberculosis control in South Korea", Emerg Infect Dis, 21, pp.1913~1920 (2015)
- Adada H, "Epidemiology of extra-pulmonary tuberculosis in the United States: high rates persist in the post-HIV era", Int J Tuberc Lung Dis, 18, pp.1516~1521 (2014)
- Mou Y, "Esophageal tuberculosis initially misdiagnosed by endoscopy as a submucosal tumor", Endoscopy, 47(Suppl 1 UCTN), pp.E30~E31 (2015)
- Kang MJ, "Esophageal tuberculosis presenting as a submucosal tumor", Clin Gastroenterol Hepatol, 6, pp.A26~ (2008)
- Huang YK, "Esophageal tuberculosis mimicking submucosal tumor", Interact Cardiovasc Thorac Surg, 3, pp.274~276 (2004)
- "Global tuberculosis report 2015" (2016)[URL]
- Bai GH, "Trend of anti-tuberculosis drug resistance in Korea, 1994-2004", Int J Tuberc Lung Dis, 11, pp.571~576 (2007)
- 최재철, "Drug Resistance Rates of Mycobacterium tuberculosis at a PrivateReferral Center in Korea", Journal of Korean Medical Science, 22(4), pp.677~681 (2007), 대한의학회
- Park HJ, "A clinical study of tuberculous lymphadenitis", Tuberc Respir Dis, 48, pp.730~739 (2000)
- Ko Y, "Esophagomediastinal fistula secondary to multidrug-resistant tuberculous mediastinal lymphadenitis", Intern Med, 53, pp.1819~1824 (2014)
- Geake J, "Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience", J Thorac Dis, 7, pp.439~448 (2015)