A suppurated, fistulized lymphadenitis in the neck: The unta
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Cervical lymphadenopathy is the most frequent form of extrapulmonary tuberculosis. A 35 year-old Albanian man presented with a 3-month history of bilateral, gradual swelling of the front of his neck.

He had emigrated from Albania six and a half years previously and had been itinerant with no fixed address and poor access to medical care. He was diagnosed with dental disease during an emergency visit to a dentist and provided with a 2 week course of antibiotics, which did not resolve his symptoms. He complained of general malaise, but was able to work.

On examination, he was found to have a fluctuating palpable mass on the front of his neck, which was more marked on the right and small discharging fistulae. The lymph nodes were fixed, and the overlying skin was indurated. The discharge was whitish and viscous. On chest auscultation, he was found to have crackles and rhonchi at the base of his right lung. Laboratory tests revealed an elevated ESR(40 mm/h) and an elevated C-reactive protein level (24 mg/L)

A plain chest radiograph revealed cavitating tuberculosis. Sputum and cervical lymph node aspirate were both positive for Mycobacterium tuberculosis on Ziehl Neelsen stain, and Xpert MTB/RIF (Cepheid Inc) revealed that the strain was nonresistant to rifampicin. The patient was referred to a specialized center for further evaluation, and two samples were tested for drug susceptibility using the Mycobacteria Growth Indicator Tube 960 system.

The patient was started on standard therapy for tuberculosis, with a regimen of four antitubercular drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol).

Diagnosis of tuberculous cervical lymphadenopathy is a challenge. Cervical lymphadenopathy is the most frequent form of extrapulmonary tuberculosis, but bilateral tuberculous cervical lymphadenopathy is uncommon.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3460?af=R
Like
Comment
Share