Ann Rehabil Med.  2019 Dec;43(6):725-729. 10.5535/arm.2019.43.6.725.

Secondary Lymphedema After Intestinal Tuberculosis: A Case Report

• Hong JW
• Park HE
• Shin MJ
• Shin YB
• Yoon JA

• KMID: 2468699
• DOI: http://doi.org/10.5535/arm.2019.43.6.725

Abstract

Lymphedema, a chronic disease that lowers patients' quality of life, is categorized as primary or secondary. Secondary lymphedema can be improved by treating the underlying cause. However, in many cases, efforts are not made to identify the primary cause of lymphedema and treatment is targeted at the edema itself, resulting in misdiagnosis. Here, we describe the case of a 61-year-old man with right leg edema of unknown cause that had persisted for 3 years. Intestinal tuberculosis was confirmed during a re-evaluation of the cause, and his symptoms improved after anti-tuberculous treatment. This improvement was assessed qualitatively by indocyanine green lymphography before and after treatment, as well as by observation of the clinical symptoms. Lower extremity lymphedema caused by intestinal tuberculosis is extremely rare, and this case reveals the importance of continuing to identify the causes of resistant pathologies.

Keyword

Lymphedema; Tuberculosis; Secondary lymphedema

MeSH Terms

Chronic Disease
Diagnostic Errors
Edema
Humans
Indocyanine Green
Leg
Lower Extremity
Lymphedema*
Lymphography
Middle Aged
Pathology
Quality of Life
Tuberculosis*
Indocyanine Green

Figure

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  Fig. 1. Lymphoscintigraphy showing r ight pelvic lymph node obstruction: (A) anterior (40 minutes, alpha value of 30%), (B) posterior (alpha value of 30%), (C) anterior (40 minutes), and (D) posterior.

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  Fig. 2. Indocyanine green lymphography: (A) mixed stardust and diffuse patterns below the knee and (B) visible splash pattern near the ankle after antituberculosis treatment.

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  Fig. 3. Abdominal computed tomography scan showing colonic wall thickening (arrow) without visualization of necrotic lymph nodes.

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  Fig. 4. Improvement of right-leg edema near the ankle after management of the causative factor, correlated with follow-up indocyanine green lymphography findings.

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