Krakamp B, Leidig P, Chemaissani A, Stolte M
Medizinische Klinik I, Krankenhaus Merheim, Germany.
Eur J Gastroenterol Hepatol. 1995 Nov;7(11):1123-5. doi: 10.1097/00042737-199511000-00016.
We report on a 58-year old female patient from Afghanistan, who developed a dysphagia within 3 weeks of arrival. On the basis of radiological and endoscopic examination, an oesophageal ulcer was regarded as a malignant tumour, but because of weight loss, fever and night sweats (B symptoms) the question of tuberculosis was also considered by the pathologist. Histological assessment of biopsies produced proof of epithelioid cell granulomas with marginally polygonal giant cells of Langhans-type, as of acid-fast bacilli. In a bacteriological test, three different types of mycobacteria were found. With adequate anti-tuberculosis therapy, the oesophageal ulcer and the mediastinal lymph nodes visible in the computed tomograph soon disappeared, and the patient became free of symptoms. The clinical picture was interpreted as a primary oesophageal tuberculosis with mediastinal lymph nodes as the primary complex. In cases of oesophageal ulcer or dysphagia, tuberculosis should be included in the differential diagnosis, particularly in patients from Asia.
我们报告了一名来自阿富汗的58岁女性患者，她在抵达后的3周内出现吞咽困难。根据放射学和内镜检查，一个食管溃疡被视为恶性肿瘤，但由于体重减轻、发热和盗汗（B症状），病理学家也考虑了结核病的问题。活检的组织学评估证实存在上皮样细胞肉芽肿，伴有边缘呈多边形的朗汉斯型巨细胞，未发现抗酸杆菌。在细菌学检测中，发现了三种不同类型的分枝杆菌。经过适当的抗结核治疗，食管溃疡以及计算机断层扫描中可见的纵隔淋巴结很快消失，患者症状消失。临床症状被解释为原发性食管结核，纵隔淋巴结为原发综合征。在出现食管溃疡或吞咽困难的病例中，尤其是来自亚洲的患者，应将结核病纳入鉴别诊断。
