A 32-year-old man was admitted complaining of fever and cough. Chest X-ray and computed tomography showed left hilar and mediastinal lymph node swelling. We performed a lymph node biopsy by mediastinoscopy that was diagnosed as hilar (mediastinal) tuberculous lymphadenitis. Just after mediastinoscopy, the patient vomited with hematemesis, and was diagnosed as esophageal perforation resulting from hilar (mediastinal) tuberculous lymphadenitis by emergent upper gastrointestinal endoscopy. He was treated with antituberculous drugs. Two-and-half-months later, a chest X-ray and CT films showed infiltrative shadows in the bilateral lung fields, and we diagnosed as endobronchial perforation because of hilar (mediastinal) tuberculous lymphadenitis by bronchoscopy. Five months later, right cervical cutaneous fistula was revealed. Thereafter the patient improved gradually. Later, after 5, 10, and 19 months of antituberculous chemotherapy, the esophageal perforation, the cervical cutaneous fistula and the endobronchial perforation were respectively reduced and eventually disappeared. After 23 months, the hilar (mediastinal) lymphadenopathy was reduced in size, and the antituberculous chemotherapy was finished. After 36 months, no recurrent signs are seen and the patient is showing good statement.