Abstract
Gastric tuberculosis is a rare disease and only thirteen cases diagnosed by endoscopic biopsy have been reported in Japan. A 51-year-old women complaining of mild epigastric pain had an upper GI series in another institution, and was referred to our hospital because of an angle deformity. The upper GI endoscopy revealed an edematous mucosa on the angle and the antrum associated with multiple irregular small ulcers . These findings were suggestive of idiopathic inflammatory disease of the stomach or acute multiple gastric ulcers. Because epithelioid cell granulomas with Langhans giant cells were found in thebiopsy specimens, a tentative diagnosis of gastric tuberculosis was made . Chemotherapy with SM, INAH, RFP was initiated, but the follow-up study performed a month later failed to disclose any improvement. Furthermore, a definite caseous necrosis was found in a biopsy specimen taken from the lesion. Therefore, perendoscopic injection of lg SM was performed eight times, at weekly intervals, and the gastric lesions disappeared. This case is considered worth recording because of the evidence of caseous necrosis in a biopsy specimen and the therapeutic superiority of endoscopic local injection of SM over systemic therapy.
