The rare multidrug cervical tubercular lymphadenitis in an I
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Tuberculosis (TB) remains as a nightmare for the public health. It has various forms, including the cervical tuberculosis lymphadenitis (CTL), classically known as “scrofula,” which is the most common form of extrapulmonary tuberculosis that often affects children.

A 32 year-old pregnant mother at her 34 weeks of gestation was referred to Hospital due to weight loss, fever, persistent, coughing, and dyspnea. She was diagnosed by sputum smear and culture examination to have pulmonary tuberculosis. The patient was treated for category I tuberculosis, and her symptoms became gradually negative in accordance with the sputum smear results. However, she delivered about one month later at 41 weeks gestation. Despite receiving prophylactic TB therapy (isoniazid), 55 days after his birth, the child (boy infant) was affected by fever (38.3°C), anorexia, and a painful swollen lesion in the neck area.

Since the mother had tuberculosis during pregnancy, the baby was also diagnosed as a “TB Case” and treated with isoniazid and rifampicin. Although the neck mass biopsy results showed evidence of inflammation, they were negative for the acid-fast bacilli. The child's cervical swelling did not improve after about 4 months of antituberculosis therapy and had a pale colored discharge.

The parents of this patient were not satisfied about the lumbar puncture of the baby and the disseminated TB was ignored based on the radiological findings and negative culture of blood for Mtb. The patient underwent FNA (fine needle aspiration) and the patient's biopsy specimen revealed numerous evidences of multiple necrotizing granulomas with caseous lesions.

The standard proportional method analysis showed resistance to isoniazid, rifampicin, and ethambutol. It has been more probable that the patient was infected with Mtb as congenitally route. However, the patient was treated with a combination therapy including surgical drainage and antibiotic therapy by ethionamide, moxifloxacin, amikacin, and linezolid. Other members of the patient's family also received prophylactic MDR-TB (with moxifloxacin).

After one year and regular follow-up of the patient, it was found that the patient was fully recovered, and no signs of reactivation were observed in the patient, his mother, and their other family members.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3612?af=R
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