Nakayama et al. Journal of Medical Case Reports 2010, 4:24 http://www.jmedicalcasereports.com/content/4/1/24 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Prompt improvement of a pressure ulcer by the administration of high viscosity semi-solid nutrition via a nasogastric tube in a man with tuberculosis: a case report Tamaki Nakayama, Seiji Hayashi*, Kyoichi Okishio, Tomoko Tomishiro, Kaori Hosogai, Yuki Ootsu, Yasushi Morioka, Kazuyoshi Hatsuda, Eriko Naito, Mitsunori Sakatani Abstract Introduction: Semi-solid nutrition with high viscosity has the advantage of reducing gastroesophageal reflux and diarrhea and shortens the duration of administration compared with liquid nutrition. This is the first report describing the administration of semi-solid nutrition with high viscosity via a nasogastric tube, which achieved a remarkable improvement in the patient’s nutritional state. Case presentation: A 67-year-old man (mongoloid race, Japanese) with tuberculosis, a pressure ulcer and malnutrition was admitted to our hospital. He also had right hemiplegia, dysphagia and aphasia as sequelae of a cerebral hemorrhage. Before his admission, he had been treated at another hospital with 600 kcal/day of liquid nutrition via a nasogastric tube, which was insufficient and induced severe malnutrition. After he was admitted to our hospital, we increased the quantity of his liquid nutrition without success because of complications, specifically diarrhea and gastroesophageal reflux. As it was difficult to confirm whether or not he would accept gastrostomy feeding, we administered semi-solid nutrition with high viscosity (20,000 mPa x s) via a large-bore nasogastric tube (18 French). Soon after he was started on semi-solid nutrition, his pressure ulcer and malnutrition improved without diarrhea or complications accompanying the large-bore nasogastric tube. Conclusion: When patients have problems with liquid nutrition, such as diarrhea or gastroesophageal reflux, semi- solid nutrition via a nasogastric tube is a useful method of achieving improvements in nutritional state in a short period of time. Introduction Enteral nutrition has surpassed parenteral nutrition in terms of safety and physiological benefits [1,2]. For a patient who has problems swallowing but has an intact intestinal tract, enteral nutrition is primarily recom- mended [1]. Semi-solid enteral nutrition has the advan- tage of lowering the risk of diarrhea and esophageal reflux [3]. Here we report a case in which malnutrition, diarrhea and a pressure ulcer were improved by high viscosity semi-solid nutrition via a large-bore nasogastric tube. * Correspondence: shayashi@kch.hosp.go.jp National Hospital Organization Kinki-Chuo Chest Medical Center, Nagasone- Cho, Kita-Ku, Sakai-City, Osaka, 591-8555, Japan Case presentation A 67-year-old man (mongoloid race, Japanese) was admitted to our hospital because of a 3-day history of fever. Acid-fast bacilli was found to be smear-positive in his sputum, and a chest radiograph and computed tomography examinations showed parenchymal opacities with scattered fine nodules in his right apical region. He was diagnosed with pulmonary tuberculosis, so he was started on anti-tuberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide on the first day that he was hospitalized. He had developed a cere- bral hemorrhage 18 months before this hospitalization, and he had right hemiplegia, dysphagia, and aphasia as sequelae. He had been receiving 600 kcal/day of liquid © 2010 Nakayama et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.