부산대학교 도서관

Tuberculosis rarely involves the esophagus, and the most esophageal tuberculosis occurs secondary to adjacent tuberculous lymphadenitis. Esophago-mediastinal fi stula is very rare complication of tuberculous lymphadenitis. A 28-year-old, previously healthy female visited the outside hospital due to nausea, vomiting, and fever. Chest CT(Computed tomography) showed enlargement of multiple, mediastinal lymph nodes with air density in the mediastinum, and thus suggesting an esophago-mediastinal fi stula. Esophagogram showed the extraluminal contrast leakage in cervical esophagus. Esophagogastroduodenoscopy(EGD) showed the deep ulcer with the fi stula opening at 24cm from the upper incisor teeth. Tuberculosis(Tb) polymerase chain reaction(PCR) on the sputum was positive. A biopsy of the right subclavian lymph node revealed necrotizing granuloma with Tb PCR positive. We diagnosed as tuberculous mediastinal lymphadenitis with esophago-mediastinal fi stula. The referring doctor failed to close the fi stula by endoscopic clipping. Therefore, we decided to use anti-Tb medications to treat fi stula via gastrostomy, because of severe nausea and vomiting. After four weeks, EGD and esophagogram showed that the fi stula opening was closed. The present case highlights the importance of anti-Tb medications in treatment of esophago-mediastinal fi stula due to tuberculous mediastinal lymphadenitis. n.