• Masayoshi Minakuchi, Eisaku Tanaka, Tetsuro Inoue, Minoru Sakuramoto, Yuji Maeda, Ko Maniwa, and Yoshio Taguchi.
• Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho, Tenri-shi, Nara 632-8552, Japan. minakuchi@tenriyorozu-hp.or.jp
• Kekkaku. 2005 Jan 1; 80 (1): 19-23.

AbstractA 27-year-old man was admitted to our hospital due to a painful mass in the right neck and fever. Cervical and superior mediastinal computed tomography showed an enlargement of right supraclavicular lymph node and multiple swollen mediastinal lymph nodes, including low-density areas and contrast medium-enhanced septa and margins. Smears of the pus obtained from right supraclavicular lymph node showed acidfast bacilli identified as Mycobacterium tuberculosis by PCR method. He was treated with antituberculous drugs with INH, RFP, EB, and PZA. PZA was given for initial two months. Six months later, productive cough developed and chest X-ray films showed infiltrative shadow in the right upper lung field. One month after the onset of cough, bronchoscopy revealed a polypoid lesion with a white coating in the right main bronchus. Microscopic examination of the specimen obtained by transbrochial biopsy revealed many epithelioid cell granulomas, consistent with tuberculosis. From these findings, pulmonary lesion was suggested to be due to invasion of the mediastinal lymph node into the bronchus. After one year of antituberculous chemotherapy, the swelling of the cervical-mediastinal lymph nodes was reduced and the abnormal chest X-ray shadows disappeared.

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