Cervical Lymphadenopathy—Pitfalls of Blind Antitubercular Treatment.

Tuberculosis (TB) is the most common cause of cervical lymphadenopathy in the TB-endemic zone, like India but it can also mimic other diseases. Four cases of cervical lymphadenopathy presented to us as initial treatment failure after completion of six months of antitubercular drugs (ATD), including rifampicin, isoniazid, pyrazinamide, and ethambutol. All were diagnosed as having tuberculosis either by fine needle aspiration cytology or clinically from outside our institution. In one case, tuberculosis was the final diagnosis but, unfortunately, it was multidrug-resistant. In other three cases, Hodgkin disease, Non-Hodgkin lymphoma, and Kikuchi’s disease were the diagnoses. In resource-poor countries, like India, which is also a TB-endemic zone, TB should be the first diagnosis in all cases of chronic cervical lymphadenopathy, based on clinical and/or cytological evidences. So, they were correctly advised antitubercular therapy (ATT) initially. Sometimes, TB mimics other aetiologies where apparent initial improvement with ATT finally results in treatment failure. Hence, investigations for microbiological and histopathological diagnosis are warranted, depending on the resources and feasibility. If these tests are not routinely available, the patients should be under close monitoring so that lymphoma, drug-resistant TB, or other aetiologies of cervical lymphadenopathy are not missed. Patients with cervical lymphadenopathy rarely presents acutely; so, a physician can take the opportunity of histopathological study of lymphnode tissue.

A Rare Case of Mycobaterium Avium Complex (MAC) Infection in an Immunocompetent Person.

It is well known that Mycobaterium avium complex (MAC) infection occurs commonly in immunecompromised patients. We are reporting a case of MAC infection in a person in whom no evidence of immune-compromisation has been found despite thorough examination.

A rare case of concurrent multiple primary lung cancer of different histological types.

Occurrence of concurrent multiple primary malignancies with different histopathological presentations of the same organ at the same time is often not diagnosed and rarely reported in the literature. We present a case of multiple primary lung cancers with hepatic metastasis where the patient had a moderately differentiated adenocarcinoma of the right lower lobe and a moderately differentiated squamous cell carcinoma of the right upper lobe.