Manca Sandra, Fois Alessandro Giuseppe, Santoru Luigi, Trisolini Rocco, Polo Maria Francesca, Ostera Salvatore, Patelli Marco, Pirina Pietro
Department of Respiratory Disease, University of Sassari, Sassari, Italy.
Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
Am J Case Rep. 2015 Apr 24;16:240-4. doi: 10.12659/AJCR.892546.
Pulmonary tuberculosis (TB), a highly contagious infectious disease, is a significant public health problem all over the world and remains an important cause of preventable death in the adult population. Endobronchial TB is an unusual form of thoracic TB that may be complicated by tracheobronchial stenosis, and bronchoesophageal fistula formation is a very rare complication. Tubercular lymphadenitis can also lead to fistula formation through a process of caseum necrosis and opening of a fistula between the bronchus and oesophagus.
We report an uncommon case of thoracic TB in an immunocompetent 73-year-old Caucasian man who presented several problems: bronchoesophageal fistula, endobronchial TB, and mediastinal lymphadenopathy in the absence of contemporary parenchymal consolidation. Furthermore, he presented a normal chest radiograph and mostly unclear and non-specific symptoms at onset.
We emphasize the need for a better knowledge of this illness and awareness that it may have an unusual presentation. In these cases, diagnosis and proper treatment can be delayed, with severe complications for the patient. Pulmonary TB remains a real diagnostic challenge: a normal chest radiograph and nonspecific symptoms do not allow us to exclude this persistent infectious disease.
肺结核是一种高度传染性的传染病，是全球重大的公共卫生问题，仍是成人可预防死亡的重要原因。支气管内膜结核是一种不常见的胸段结核形式，可能并发气管支气管狭窄，而支气管食管瘘形成是一种非常罕见的并发症。结核性淋巴结炎也可通过干酪样坏死过程以及支气管与食管之间瘘管的开放导致瘘管形成。
我们报告一例罕见的胸段结核病例，患者为一名73岁免疫功能正常的白种男性，存在以下几个问题：支气管食管瘘、支气管内膜结核和纵隔淋巴结病，且无同期实质浸润。此外，他发病时胸部X线片正常，症状大多不明确且无特异性。
我们强调需要更好地了解这种疾病，并意识到它可能有不寻常的表现。在这些病例中，诊断和恰当治疗可能会延迟，给患者带来严重并发症。肺结核仍然是一个真正的诊断挑战：胸部X线片正常和症状不具特异性并不能让我们排除这种持续性传染病。
