Mao Lei, Zhou Xue-Ting, Li Ji-Pin, Li Jun, Wang Fang, Ma Hui-Min, Su Xiao-Lu, Wang Xiang
Department of Gastroenterology, The Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China.
World J Clin Cases. 2020 Feb 6;8(3):645-651. doi: 10.12998/wjcc.v8.i3.645.
Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis (ET) is still rare. Intestinal tuberculosis (ITB) is relatively more common, but there are few reports of ET complicated with ITB. We report a case of secondary ET complicated with ITB in a previously healthy patient.
A 27-year-old female was hospitalized for progressive dysphagia, retrosternal pain, acid regurgitation, belching, heartburn, and nausea. Upper gastrointestinal endoscopy showed a mid-esophageal ulcerative hyperplastic lesion. Endoscopic ultrasonography showed a homogeneous hypoechoic lesion, with adjacent enlarged lymph nodes. Biopsy histopathology showed inflammatory exudation, exfoliated epithelial cells and interstitial granulation tissue proliferation. Colonoscopy revealed a rat-bite ulcer in the terminal ileum and a superficial ulcer in the ascending colon, near the ileocecal region. The ileum lesion biopsy showed focal granulomas with caseous necrosis. Polymerase chain reaction for was positive in the esophageal and ileum lesion biopsies. The T-cell spot tuberculosis test was also positive. The patient was diagnosed with secondary ET infiltrated by mediastinal lymphadenopathy and complicated with ITB, possibly from the -infected esophageal lesion. After 2 mo of anti-tuberculosis therapy, her symptoms improved significantly, and upper gastrointestinal endoscopy showed healing ulcers.
When dysphagia or odynophagia occurs in patients at high-risk for tuberculosis, ET should be considered.
尽管近年来欠发达地区结核病的总体发病率有所上升，但食管结核（ET）仍然罕见。肠结核（ITB）相对较为常见，但ET合并ITB的报道较少。我们报告一例既往健康患者发生继发性ET合并ITB的病例。
一名27岁女性因进行性吞咽困难、胸骨后疼痛、反酸、嗳气、烧心和恶心入院。上消化道内镜检查显示食管中段溃疡性增生性病变。内镜超声检查显示均匀的低回声病变，伴有相邻肿大淋巴结。活检组织病理学显示炎症渗出、脱落的上皮细胞和间质肉芽组织增生。结肠镜检查显示回肠末端有鼠咬状溃疡，升结肠靠近回盲部有浅表溃疡。回肠病变活检显示局灶性肉芽肿伴干酪样坏死。食管和回肠病变活检的聚合酶链反应检测结果为阳性。结核菌素T细胞斑点试验也呈阳性。该患者被诊断为继发性ET伴纵隔淋巴结肿大浸润并合并ITB，可能源于感染的食管病变。经过2个月的抗结核治疗，她的症状明显改善，上消化道内镜检查显示溃疡愈合。
当结核病高危患者出现吞咽困难或吞咽痛时，应考虑ET。
