Cervical tuberculous lymphadenitis in an elderly pt: BMJ cas
A 94-year-old man presented with complaints of increasing fatigue and generalised weakness for 1 month’s duration. On admission, the patient had tachycardia of 112 bpm and fever of 101.1 °F. His initial physical examination was otherwise normal. Lactic acid was elevated (4.13 pg/mL), but other laboratory markers were within normal limits.

The lactic acidosis resolved after administration of normal saline, but he continued to have fever, which prompted more thorough physical examination that revealed a painless right-sided neck mass. CT of the neck without contrast confirmed a low-density neck mass in the right posterior cervical region measuring 7 cm in the maximum diameter (figures 1 and 2), suspicious for necrotic tumour or an abscess. Ultrasound-guided drainage of the mass recovered 50 mL of purulent material that was submitted for microbiological analysis and cytology.

The sample contained inflammatory cells and debris, but was negative for malignancy. Numerous acid-fast bacilli (AFB) were identified on AFB smear, and the patient was started on the quadruple antituberculous regimen of isoniazid, rifampin, pyrazinamide and ethambutol based on high clinical suspicion for Mycobacterium tuberculosis.

PCR and sputum AFB cultures ultimately confirmed the presence of M. tuberculosis, and no resistance to rifampin was reported. HIV test was negative. On further questioning, the patient and his family members denied any contacts with persons with known or suspected tuberculosis.

The treatment resulted in significant decrease in size of lymphadenopathy without any significant toxicity.

However, despite these reassuring initial observations, the patient continued to deteriorate over the subsequent weeks. Given his overall poor prognosis, medical care was transitioned to hospice and the patient passed away shortly thereafter.

Know more here: http://casereports.bmj.com/content/2018/bcr-2018-225706.full
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