[A CASE OF PULMONARY FLARE-UP TUBERCULOSIS WITH AN ESOPHAGO-BRONCHIAL FISTULAS AFTER CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER].

Abstract

We present a case of a 59-year-old man with pulmonary tuberculosis and esophago-bronchial fistulas after chemoradiotherapy (CRT) for esophageal cancer. A lung nodule was detected in the right upper lobe and diagnosed as an inactive old inflammatory tumor by several examinations, including bronchoscopy. He was admitted to our hospital because of dysphagia 3 months later. The esophagoscopy showed advanced, stage IVa esophageal cancer. He received CRT at the university hospital and experienced partial remission. Two months later, he called an ambulance for dyspnea and chest roentgenography showed pneumonia in the right lung fields. The respiratory failure was severe and required mechanical ventilation. The intubation and bronchoscopy were performed in the emergency room. The bronchoscopy showed the esophago-bronchial fistulas due to recurrent esophageal cancer and backward flow of digestive juice. Mycobacterium tuberculosis was isolated from aspi- rated sputum several days later. Administrations of isoniazid/ levofloxacin and intramuscular injection of streptomycin were started. The patient moved to a medical center with a tuberculosis ward while on the respirator. The tuberculosis was not detected in the ward for 2 months. The patient returned to our hospital, but his esophageal cancer had progressed with distant metastases, he died 3 weeks later. When performing CRT, we should be careful for relapse of tuberculosis.