2017 Volume 39 Issue 5 Pages 424-429
Background. Lymphadenopathy due to silicosis, is one of the rare causes of benign esophageal-bronchial fistula. We report a case of esophageal-mediastinum fistula caused by silicosis-lymphadenopathy which was difficult to distinguish from tuberculous lymphadenitis, because of a granuloma proven in a biopsy tissue during an upper gastrointestinal endoscopic examination and with a positive result of interferon-gamma release assay test. Case. A 75-year-old man with chronic hepatitis C had an upper gastrointestinal endoscopic examination screening for esophageal varices, and an esophageal ulcer was found. A contrast CT scan revealed multiple mediastinal lymphadenopathy and esophageal-mediastinum fistula. A total of 5 upper gastrointestinal endoscope examinations did not detect malignancy but only one granuloma. A positive result of interferon-gamma release assay test suggested a diagnosis of tuberculosis. However acid-fast stain tests, PCR tests and cultures were all negative. Video assisted thoracic surgical biopsy of mediastinum lymph nodes was done, and it was found that the esophageal-mediastinum fistula was due to silicosis-lymphadenopathy. We only maintained observation and confirmed that the fistula was closed. Conclusion. We report a case of esophageal-mediastinum fistula caused by silicosis-lymphadenopathy which was difficult to distinguish from tuberculous lymphadenitis.
