Anazawa Rie, Suzuki Masaki, Miwa Hideki, Miki Yoshihiro, Tomita Kazuhiro, Nakamura Hidenori
Kekkaku. 2014 Aug;89(8):711-6.
An 88-year-old woman with rheumatoid arthritis who had started etanercept treatment in July 2011 was referred to our hospital in February 2012 for right-sided pleural effusion. Chest computed tomography showed right pleural effusion, partial swelling of a calcified mediastinal lymph node, and mid-esophageal thickening of the mucosal wall. Gastroendoscopy showed mid-esophageal ulceration. Histological examination of biopsy specimens from this ulceration revealed noncaseating granulomas with Langhans giant cells. Ziehl-Neelsen staining of this section was positive for acid-fast bacilli. Polymerase chain reaction analysis of gastric juice was positive for Mycobacterium tuberculosis; we therefore diagnosed the patient with esophageal tuberculosis. However, since abdominal computed tomography showed swelling of mesenteric lymph nodes, we also suspected intestinal tuberculosis. Colonoscopy showed multiple ileal erosions; histological analyses of biopsied specimens revealed granulomas with Langhans giant cells, similar to the esophageal findings. We finally diagnosed the patient with both esophageal and intestinal tuberculosis. After anti-tuberculosis treatment, the right pleural effusion disappeared and the abdominal lesions improved. Although mycobacterial involvement of both the esophagus and intestine is rare in immunocompromised and immunocompetent hosts, differential diagnosis of these diseases is likely to become more important.
一名88岁患类风湿关节炎的女性，于2011年7月开始使用依那西普治疗，2012年2月因右侧胸腔积液转诊至我院。胸部计算机断层扫描显示右侧胸腔积液、钙化纵隔淋巴结部分肿大以及食管中段黏膜壁增厚。胃镜检查显示食管中段溃疡。对该溃疡活检标本进行组织学检查发现有含朗汉斯巨细胞的非干酪样肉芽肿。该切片的萋-尼染色抗酸杆菌呈阳性。胃液聚合酶链反应分析结核分枝杆菌呈阳性；因此，我们诊断该患者为食管结核。然而，由于腹部计算机断层扫描显示肠系膜淋巴结肿大，我们也怀疑有肠结核。结肠镜检查显示多处回肠糜烂；活检标本的组织学分析发现有含朗汉斯巨细胞的肉芽肿，与食管病变相似。我们最终诊断该患者患有食管结核和肠结核。抗结核治疗后，右侧胸腔积液消失，腹部病变好转。尽管在免疫功能低下和免疫功能正常的宿主中，结核分枝杆菌同时累及食管和肠道的情况很少见，但对这些疾病进行鉴别诊断可能会变得更加重要。
