Abstract
We report a case of esophageal tuberculosis complicated with silicotuberculosis. The patient was an 81-year-old man who had a history of silicotuberculosis at 61 years of age. He complained of cough, sputum and sore throat. Under the diagnosis of reactivation of silicotuberculosis by sputum examination, he was referred to our sanatorium. Chest X-ray showed diffuse small nodular shadows in the bilateral lung fields, large shadows in the bilateral upper lung fields, swelling and calcification of the mediastinal lymph nodes. Upper gastrointestinal roentgenogram showed an irregular-shaped ulceration in the middle portion of the esophagus. Endoscopic examination revealed a deep ulcer at 30cm from the incisors, the base of which was covered with smoky-black coats and surrounded with granulotic mucosal margin. Histological examination revealed non-caseating epithelioid cell granuloma. Acid-fast bacilli were confirmed by Ziehl-Neelsen's stain. The culture of the biopsied specimen revealed tubercle bacilli. Chest CT scanning at the level of sixth thoracic vertebrae showed a mediastinal lymph node involving the esophagus.
It was considered that the ulcer was resulted from the perforation of a casenous gland into the esophagus, which belonged to tuberculous mediastinal lymphadenitis due to silicotuberculosis.
