• Gerald Ulrich Denk, Karl-Heinz Bergstermann, Eike Gallmeier, Jörg Schirra, Hubert Wagner, Burkhard Göke, and Rolf Lamerz.
• Medizinische Klinik II der Ludwig-Maximilians-Universität München-Grosshadern, München-Grosshadern.
• Med Klin. 2003 Nov 15; 98 (11): 641-5.

BackgroundIn spite of a decreasing incidence of tuberculosis in highly industrialized countries, an obvious increase of the disease is observed worldwide. In times of progressing international migration, the early detection of tuberculosis is also becoming important in Germany. The diagnosis, however, is often impaired by unspecific symptomatology and ambiguous imaging results.Case ReportA 27-year-old patient from Iraq presented with unclear recurring and antibiotic-resistant fever and inconspicuous thoracic X-ray. Only by thoracic computed tomography, markedly necrotizing mediastinal lymph nodes could be detected. Following lymph node biopsy and histologic investigation, the diagnosis of mediastinal lymph node tuberculosis could be ascertained. Test-adjusted antituberculotic combination treatment resulted in a normalization of body temperature and cessation of complaints. Starting from the case report presented, the importance of various investigative methods for the quick and secure diagnosis of tuberculosis and subsequent therapy are discussed.ConclusionUnclear febrile disease even in young patients with an inconspicuous conventional thoracic X-ray may be caused by tuberculosis. In this situation, early extension of imaging diagnostics appears to be advantageous.

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