A Case of Eosinophilic Granulomatosis with Polyangiitis Mimicking Cutaneous Tuberculosis and Tuberculous Lymphadenitis

Summary@#Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss Syndrome (CSS) is a rare granulomatous necrotizing vasculitic disease characterized by the presence of asthma, sinusitis, and hypereosinophilia. We describe a patient who was initially diagnosed with tuberculous lymphadenitis and later diagnosed with EGPA.

Correlation between cytomorphology and acid fast bacilli positivity in tubercular lymphadenopathy in far Western Nepal: a hospital based study

Background: Tuberculous lymphadenitis is the most common manifestation of extrapulmonary tuberculosis. Fine needle aspiration cytology (FNAC) is a valuable tool in diagnosis of tubercular lymphadenitis. The present study aims to determine the prevalence of different cytomorphological patterns in fine needle aspiration cytology of tubercular lymph nodes and their correlation with Acid Fast Bacilli (AFB) positivity on Ziehi-Neelsen (ZN) Staining.Methods: Fine needle aspiration cytology of 274 cases diagnosed as tubercular lymphadenitis over a period of a year were reviewed. Cytomorphological patterns were categorized into three patterns. Pattern I: Epithelioid granuloma without necrosis, Pattern II: Epithelioid granuloma with caseous necrosis and Pattern III: Caseous necrosis only. Fischer Exact test was applied to correlate cytomorphological pattern and AFB positivity.Results: Tuberculous lymphadenitis was most frequent in age group 21-30 years (24.81%). Cervical lymph nodes were the most frequent lymph nodes involved (84.67%). Pattern I was the most common cytomorphological pattern observed (49.3%). Overall AFB positivity was 28.10%. Maximum AFB positivity was seen in pattern III (73.3%).Conclusions: FNAC is the simple, cost effective and minimally invasive tool to diagnose tuberculous lymphadenitis. Study of both cytomorphological pattern and ZN staining for AFB can improve the diagnostic accuracy.

Use Of Cbnaat X–Pert Mtb For Rapid Diagnosis Of Tuberculous Lymphadenitis From Fine Needle Aspiration Cytology Specimens At A Tertiary Care Hospital

Background: Diagnosis of extrapulmonary tuberculosis is difficult. Tuberculous lymphadenitis is one of the most common extrapulmonary manifestation of tuberculosis.1 Cervical group of lymph nodes are commonly involved.2 Fine needle aspiration cytology can be used easily, safely for specimen collection of these cases. The cytology samples can be used for CBNAATX-pert assay for rapid diagnosis of tuberculous lymphadenitis along with fluoroscence microscopy. The aim of the present study was to evaluate proportion of tuberculous lymphadenitis from FNAC specimens of all lymphadenopathy cases, to study diagnostic utility of CBNAATX-pert MTB for diagnosis of tuberculous lymphadenopathy in patients with lymphadenitis and to correlate cytological findings with CBNAATand fluorescence microscopy results.Methods:The present study was included 45 cases of lymphadenopathy. Detailed history and physical examination was done followed by FNAC . Multiple smears were prepared from each aspirate for routine cytological examination and for evaluation by fluroscence microscopy. The cytology findings were correlated with CBNAATand fluoroscence microscopy results.Results:In the present study female preponderence was noted. Maximum number of cases were in 3rd decade. Tuberculous lymphadenitis was the most common cytological diagnosis found in 51.1 % cases, of which 33.3% were positive on CBNAATand 20% cases were positive by fluorescence microscopy.Conclusion:The most common cause of cervical lymphadenopathy is tuberculosis. The present study supports combined use of FNAC and CBNAATfor early diagnosis of tuberculosis.

Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.

Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis / 中国医学科学杂志(英文版)

Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis. Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study. The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell (SFC)/10 6 periphreral blood monocyte cell (PBMC) according to the instruction of testing kits. The gold standard for diagnosis of TBL was the combination of microbiology results, histopathology results and patient's response to anti-TB treatment. Diagnostic efficacy of T-SPOT.TB was evaluated, including sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Among 91 patients who met the inclusion criteria, we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up. According to the gold standard, there were 37 cases of true TBL (9 confirmed TBL and 28 probable TBL), 30 cases of non-TBL, and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses. The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%, 66.7%, 79.1%, 76.7%, 83.3%, 2.68 and 0.16, respectively. The number of SFCs of T-SPOT.TB in TBL patients [432(134-1264)/10 6 PBMCs] was higher than that in non-TBL patients [0 (0-30) /10 6PBMCs] with a significant difference (Z=-5.306, P <0.001). Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.

Tuberculosis ganglionar periférica en pediatría: 16 años de experiencia en un centro pediátrico de tercer nivel de Buenos Aires, Argentina / Peripheral tuberculous lymphadenitis in pediatrics: 16 years of experience in a tertiary care pediatric hospital of Buenos Aires, Argentina

La tuberculosis extrapulmonar representa el 1520 % de todas las formas de presentación. La tuberculosis ganglionar periférica es la segunda forma extrapulmonar más frecuente en niños de Argentina, luego de la pleural. En el Servicio de Tisiología del Hospital de Niños "Dr. Ricardo Gutiérrez", se analizaron en forma retrospectiva 92 casos de tuberculosis ganglionar periférica asistidos entre agosto, 2000-septiembre, 2015. La edad media fue 8,7 ± 5 años. Las adenopatías fueron periféricas únicas (31,5 %), periféricas múltiples (20,6 %) y periféricas asociadas a profundas (47,8 %). Predominó la localización cervical (80 %). El 80 % recibió antibioticoterapia previa, sin respuesta. El 56 % tenía foco de contagio conocido; 69 %, prueba cutánea de tuberculina positiva y 54 %, radiografía de tórax patológica. Todos iniciaron tratamiento antifímico por clínica compatible, exposición y/o prueba cutánea de tuberculina positiva, antes de la confirmación microbiológica o histológica. La evolución fue curación (81,5 %), derivación cercana al domicilio (8,7 %), abandono (8,7 %). Un paciente falleció.

Extrapulmonary tuberculosis accounts for 15-20 % of all clinical presentations of tuberculosis. Peripheral tuberculous lymphadenitis is the second most common presentation of extrapulmonary tuberculosis in children, after pleural tuberculosis, in Argentina. We analyzed 92 patients with peripheral tuberculous lymphadenitis seen at the Department of Tisiology of Hospital de Niños "Dr. Ricardo Gutiérrez" between August 2000 and September 2015. The patients' mean age was 8.7 ± 5 years. Nodal sites corresponded to single peripheral (31.5 %), multiple peripheral (20.6 %), and peripheral associated with deep nodes (47.8 %). Cervical lymph nodes were the most common site of involvement (80 %). In 80 % of patients previous antibiotic therapy had been administered, without response. The tuberculosis source was known in 56 %; 69 % had a positive tuberculin skin test; and 54 %, a pathological chest X-ray. Tuberculosis treatment was started on all patients based on clinical criteria, exposure and/or positive tuberculin skin test, prior to microbiological or histological confirmation. The clinical course was either healing (81.5 %), referral to a facility near home (8.7 %) or dropout (8.7 %). One patient died.

Comparison of Histological, Microbiological, and Molecular Methods in Diagnosis of Patients with TBLN Having Different Anti-TB Treatment Background / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The influence of anti-tuberculosis (TB) treatment history on tuberculous lymphadenitis (TBLN) diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN.</p><p><b>METHODS</b>In this study, suspected patients with TBLN and having different anti-TB treatment background were enrolled. All the samples were tested simultaneously by histology, Ziehl-Neelsen (ZN) staining, mycobacterial culture (culture), Xpert MTB/RIF (xpert), real-time PCR, and high-resolution melting curve PCR (HRM). Thereafter, the performance of these methods on samples with different anti-TB treatment background was assessed.</p><p><b>RESULTS</b>In our study, 89 patients were prospectively included 82 patients with TBLN and 7 with other diseases. The overall sensitivities of Xpert, real-time PCR, histology, ZN staining, and culture were 86.6%, 69.5%, 58.5%, 43.9%, and 22.0%, respectively. The anti-TB treatment history revealed dramatic influences on the sensitivity of culture (P < 0.0001). In fact, the treatment that lasted over 3 months also influenced the sensitivity of Xpert (P < 0.05). However, the treatment history did not affect the performance of remaining tests (P > 0.05). For rifampicin drug susceptibility test (DST), the anti-TB treatment showed only significant influence on the success rate of culture DST (P = 0.001), but not on those of Xpert and HRM tests (P > 0.05).</p><p><b>CONCLUSION</b>Other tests as well as culture should be considered for patients with TBLN having retreatment history or over 1-month treatment to avoid false negative results.</p>

Reacciones paradójicas en el tratamiento de la tuberculosis ganglionar / Paradoxical reactions during tuberculosis lymphadenitis treatment

Lymphadenitis tuberculosis is the most frequent form of non pulmonary tuberculosis. Its incidence has increased in the last years probably because HIV co-infection. Usually manifests like a swelling of lymph nodes in the cervical region without constitutional symptoms. Diagnostics tests yields are poorer than in pulmonary tuberculosis probably due to the scarce bacillus population. Treatment is the same of pulmonary tuberculosis, but paradoxical reactions are far more frequent. These reactions, specially the latest presentations ones very often are treated as recurrence of the disease. Although this is always a possibility, in most cases they are due to an hypersensitivity reaction. In this article we present an illustrative case, an update on tuberculosis lymphadenitis and a review of the paradoxical reactions during its treatment.

La tuberculosis ganglionar es la forma más frecuente de tuberculosis extrapulmonar. Su incidencia ha aumentado, probablemente por la co-infección con VIH. Su presentación clínica más habitual es con un aumento de volumen de los ganglios cervicales sin síntomas constitucionales. Las pruebas diagnósticas tienen menos rendimiento que en la tuberculosis pulmonar por ser una enfermedad con menor población bacilar. Para el tratamiento se utilizan las mismas drogas y duración que en tuberculosis pulmonar, pero existe mayor incidencia de reacciones paradojales, las que pueden ser de difícil manejo. En este artículo presentamos primero un caso clínico particularmente ilustrativo, seguido de una puesta al día sobre tuberculosis ganglionar, incluyendo una revisión sobre el manejo de sus reacciones paradójicas.

Fine needle aspiration cytology role in head and neck lesions.

Introduction: Fine Needle Aspiration Cytology (FNAC) is a simple, quick and inexpensive method in the head and neck region. It also affords a practicable and means of rationally planning surgery and causes minimal trauma to the patient and carries no risk of complications. Aim and objectives: The aim of this study was to see the frequency of various pathological conditions detected on FNAC in patients presenting with head and neck swellings and to evaluate the role of FNAC in diagnosis of head and neck swelling. Material and methods: A retrospective study was conducted in Department of Pathology, SMIMER Medical College, Surat from July 2014 to June 2015which included 250 patients with head and neck swellings presenting to Outpatient clinics. Fine Needle Aspiration Diagnosis was correlated with detail of relevant clinical findings and investigation. Results: Maximum incidence was observed in the age group 31-40 years with higher incidence among males. Out of 250 cases, 160 cases of lymph node lesions were diagnosed of which non- specific lymphadenitis was the commonest diagnosis (47%) followed by Tuberculous lymphadentities (25%). 57 cases of thyroid lesions were diagnosed, in which incidence rate of benign thyroid lesions was (84%). 12 cases of salivary gland lesions were found, among which pleomorphic adenoma was common (67%). Conclusion: It was concluded that non-Specific lymphadenitis is the commonest condition in patients presenting with neck swellings. FNAC is a simple, safe and inexpensive tool for the assessment of patients with head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.

Spectrum of lymph node lesions on cytology in rural Haryana: a retrospective analysis.

Background: Fine Needle Aspiration Cytology (FNAC) is a simple, rapid, cost effective and reliable technique which can be used as a routine outpatient department (OPD) procedure and first line of investigation in diagnosing a variety of superficial and deep lesions. Lymphadenopathy is of great clinical significance and the underlying cause may range from a treatable infectious etiology to malignant neoplasms. In this study, we describe the diagnostic utility of FNAC in the assessment of lymph node lesions with an emphasis on the diagnosis of non-neoplastic, benign and malignant neoplastic processes. Cytomorphological patterns of tuberculous lymphadenitis were also observed. Methods: This was a retrospective study and a total of 736 patients including all age groups and both sexes presenting with palpable or deep lymph nodes in FNAC clinic of our institute over a period of 2 years were included in our study. FNAC was conducted with 22-24 Gauge disposable needles attached to 20c.c syringes. Smears were fixed in 95% ethyl alcohol and stained with Papanicolaou stain. Leishman stain was done on air dried smears. Ziehl- Neelsen (ZN) staining was done wherever required. Results: Out of 736 aspirations from lymph nodes, the most frequent cause of lymphadenopathy was found to be Tuberculosis with 419 cases (56.92%). The next frequent diagnosis was reactive lymphadenitis with 193 cases (26.22%) followed by metastatic lymphadenopathy in 47 cases (6.38%). A diagnosis of lymphoproliferative disorder was rendered in 20 cases (2.71%). In 10 cases (1.35%) FNAC was inconclusive. Conclusion: In our study, the predominant cause of lymphadenopathy was tuberculous lymphadenitis, seen in more than half of total cases, followed by reactive lymphadenopathy and malignant neoplasms. FNAC was helpful in establishing the diagnosis in 98.65% of the cases.

Kikuchi-Fujimoto Disease Coexistent with Papillary Thyroid Carcinoma in a Single Lymph Node

Cervical lymphadenopathy can be developed from various causes such as viral infection, bacterial infection, Kikuchi-Fujimoto disease, tuberculosis, malignancy, and reactive changes. In patients who have malignancy, metastatic lymphadenopathy is possible but it is rare that other concomitant diseases are in the same lymph node. We experienced a case of coexistence of Kikuchi necrotizing lymphadenitis and papillary thyroid carcinoma in a single cervical lymph node. A 38-year-old man who was previously diagnosed with papillary thyroid cancer with cervical lymph nodes metastasis presented with cervical lymphadenopathy. The lymph node biopsy showed tuberculous lymphadenitis. After finishing anti-tuberculosis medication, recurrent lymphadenopathy had developed and a surgical biopsy was performed. At that time, the diagnosis was Kikuchi necrotizing lymphadenitis combined with metastatic papillary carcinoma in a single lymph node.

Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis / 감염과화학요법

Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.

A Rare Case of Scrofuloderma with Parotid Gland Lymphadenitis / 대한피부과학회지

No abstract available.

Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease

OBJECTIVE: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. MATERIALS AND METHODS: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. RESULTS: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. CONCLUSION: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

Study of incidence of tuberculosis in fine needle aspiration cytology of cervical lymph node: a city based study.

Tuberculous cervical lymphadenitis is commonly encountered in clinical practice. Fine Needle Aspiration Cytology (FNAC) being a simple out-patient diagnostic procedure is well accepted by patients and has practically no complications. Methods: The present study involved 80 patients of cervical lymphadenopathy, who attended the pathology department of the L N medical college and JK hospital, Bhopal from June 2013 to May 2014. After a detailed history and clinical examination, fine needle aspiration cytology of involved nodes was performed in all these patients. Results: Out of 80 cases 32 (40%) cases were of tubercular lymphadenitis, 24 (30%) cases were of reactive hyperplasia of lymph node, 12 (15%) cases were of metastatic deposit of squamous cell carcinoma of lymph node, 10 (12.5)cases were of non-specific lymphadenitis, one case (1.25) was of acute on chronic lymphadenitis and one (1.25) case was of non-Hodgkin’s lymphoma, so out of 80 cases maximum number of cases (32) were of tuberculous lymph node. Conclusion: FNAC has emerged as a first-line diagnostic technique in tuberculosis lymph node. In cervical lymphadenopathy tuberculosis remains a common cause.

Detection of Mycobacterium in fine-needle aspiration biopsy specimens from children with tuberculous lymphadenitis / 中华微生物学和免疫学杂志

Objective To improve the diagnosis of tuberculosis ( TB) by analyzing Mycobacterium infection in fine-needle aspiration biopsy specimens from children with tuberculous lymphadenitis .Methods Fine-needle aspiration biopsy was performed on 269 children with tuberculous lymphadenitis diagnosed by Shanghai Public Health Clinical Center from January 2011 to September 2013 .The needle aspiration biopsy specimens were processed for acid-fast bacillus (AFB) smear test, mycobacterial culture and Mycobacterium identification ( p-nitrobenzoic acid inhibition test ) .Results Cytological diagnosis of tuberculous lymphade-nitis was made for 269 patients.The positive results by AFB smear test were detected in 63.19% of 269 specimens (n=170) and 40.15%(n=108) specimens were positive in mycobacterial culture .The differ-ence between the two tests were significant (P<0.01).The positive rate of Mycobacterium detected by using BACTEC MGIT 960 automated system and L?wenstein-Jensen culture method were 38 .66% ( n=104 ) and 28.99%(n=78), respectively, showing the significant difference between two tests (P<0.05).AFB smear test in combination with mycobacterial culture could precisely diagnose 70.63% of tuberculous lym-phadenitis in children.Of the 108 clinical isolates, 105 strains (97.2%) were Mycobacterium tuberculosis complex and the rest were non-tuberculous Mycobacterium strains (2.8%).Conclusion The positive rate by AFB smear test was significantly increased in fine needle aspiration biopsy specimens after a series of treatments including sample digestion , centrifugation and precipitation , but the positive rate of mycobacterial culture was reduced .Diagnostic accuracy could be significantly improved by using BACTEC MGIT 960 sys-tem.Mycobacterium tuberculosis complex was the predominant pathogenic bacterium in children with tubercu-lous lymphadenitis .

Cytomorphological patterns in the Diagnosis of Tuberculous lymphadenitis.

The reliable diagnosis of tuberculous lymphadenitis by FNAC has important implications in a developing country like India. The aim is to study various cytomorphological patterns seen in tuberculous lymphadenitis and their correlation with AFB positivity. Fine needle aspiration cytology (FNAC) was performed on three hundred and twenty two patients with lymphadenopathy referred to the cytopathology section of pathology department, Sri Guru Ramdas Institute if Medical sciences and research Amritsar from August 2010 to July 2012. The patients with cytological diagnosis of tuberculous lymphadenitis were followed for their response to antitubercular treatment. A total of 322 FNACs were performed on patients with lymphnode lesions; out of which the most common (119) cytological diagnosis was tuberculous lymphadenitis. The most common pattern observed was (group II) presence of epitheloid granuloma with caseation necrosis which was seen in about half (50.5%) of the cases followed by smears with caseation necrosis only (group III) (27.7%) and smears with epitheloid granulomas only (group I) (21.8%).The overall AFB positivity was seen in 19.3% cases of tuberculous lymphadenitis. Maximum (30.3%) AFB positivity was seen in smears (group III) with only necrotic debris without granuloma and was least in group I (7.6%).While comparing Group I smears with that of group III using Fisher’s exact test, the difference in AFB positivity between the smears was statistically significant as the two-tailed p value was 0.0496. Thus FNAC is safe, easy, quick reliable as well as conclusive for the diagnosis of tuberculous lymphadenitis when done along with Zeihl Neelsen stain for acid fast bacilli.

Extensive Tuberculous Lymphadenitis Mimicking Distant Lymph Node Metastasis on F-18FDG PET/CT in a Patient with a History of Malignant Melanoma

18-Fluoredeoxyglucose position emission tomography and computed tomography (F-18FDG PET/CT) scanning has been useful in the evaluation of malignant disorders and has been extensively used in cancer screening.1 However, F-18FDG uptake was not found to be specific for cancer diagnosis. Here, we describe increased F-18FDG uptake on PET/CT caused by extensive tuberculous lymphadenitis in a 62-year-old woman with malignant melanoma.

A Case of Atypical Cutaneous Tuberculid in an Immunocompromised Patient / 대한피부과학회지

Cutaneous tuberculids are relatively rare hypersensitivity reactions to Mycobacterium tuberculosis, characterized by erythematous eruption on the skin of a tuberculosis patient. Papulonecrotic tuberculid, lichen scrofulosorum, erythema induratum and nodular tuberculid were originally included in tuberculids. However, some cases are difficult to classify into the subtypes because of their broad spectrum of cutaneous manifestations and various histopathologies. This is particularly true in immunocompromised patients. We report a case of atypical cutaneous tuberculid in an immunocompromised patient in whom mycobacterical DNA was not demonstrated by PCR. However, the diagnosis of latent tuberculous infection was supported by IFN-gamma assay (QuantiFERON(R)-TB Gold test) and tuberculous lymphadenitis was diagnosed. The skin lesions responded dramatically to anti-tuberculous therapy, and there has been no evidence of recurrence.

Adenitis tuberculosa por Mycobacterium bovis: reporte de caso / Tuberculous adenitis from Mycobacterium bovis: a case report

Introducción. La linfadenitis tuberculosa, que en la actualidad es producida con mayor frecuencia por Mycobacterium tuberculosis, alguna vez fue causada esencialmente por Mycobacterium bovis. Objetivo. Describir un caso clínico con adenitis tuberculosa por Mycobacterium bovis que resulta infrecuente. Caso Clínico. Mujer con antecedentes de salud y costumbre de ingerir leche cruda y derivados de la leche caseros no supervisados desde el punto de vista sanitario con adenitis cervical de más de 5 meses de evolución sin otro síntoma. El diagnóstico de adenitis tuberculosa por Mycobacterium bovis se realizó por biopsia, ELISA, RCP y cultivo. Discusión. Aproximadamente del 11 al 25 por ciento de todos los casos de TB son exclusivamente extrapulmonares. La linfadenitis cervical es la presentación periférica más frecuente de esta enfermedad. El tratamiento es aconsejable con 4 fármacos. La cirugía queda reservada para los procedimientos diagnósticos y las complicaciones. Conclusiones. La infección por Mycobacterium bovis es infrecuente en nuestro medio, no obstante debe tenerse en cuenta en la valoración diagnóstica de todo paciente con un síndrome adénico de localización cervical y elementos epidemiológicos.

Introduction. Tuberculous lymphadenitis, which currently is most often caused by Mycobacterium tuberculosis, was once mainly caused by Mycobacterium bovis. Objective. To describe an unusual case of tuberculous adenitis from Mycobacterium bovis. Case report. A woman with a history of consuming raw milk and unsupervised dairy home-made products presents with cervical adenitis of 5 month course unassociated to other symptoms. A diagnosis of Mycobacterium bovis tuberculous adenitis was made by biopsy, ELISA, PCR and culture. Discussion. Approximately 11 to 25 percent of all TB cases are extrapulmonary exclusively. Cervical lymphadenitis is the most common presentation of peripheral disease. Treatment usually is based on four drugs. Surgery is indicated for diagnostic procedures and complications. Conclusion. Mycobacterium bovis infection is uncommon in our environment, but must be considered in the diagnostic evaluation of all patients with cervical adenitis and epidemiological correlations.