Active intestinal tuberculosis with esophageal candidiasis due to idiopathic CD4(+) T-lymphocytopenia in an elderly woman

We describe a case of intestinal tuberculosis and esophageal candidiasis in an 85-year-old Japanese woman with idiopathic CD4(+) T-lymphocytopenia (IC L). The patient exhibited clinical symptoms of odynophagia, bloody diarrhea , and high fever. Physical examination on admission showed a poor nutrition al status. Endoscopic examination of the upper digestive tract revealed the esophageal mucosa to be covered with yellowish-white plaque-like lesions. Colonoscopic examination revealed multiple annular ulcerations with bleedin g. She was diagnosed with intestinal tuberculosis by polymerase chain react ion (PCR) and fecal culture. Her CD4(+) T-lymphocyte count was 178/mm(3) an d no evidence of human immunodeficiency virus (HIV) infection was found. Sh e was successfully treated with fluconazole and antituberculosis drugs. Thi s case emphasizes the importance of opportunistic infections in elderly pat ients with predisposing conditions such as ICL.