ABSTRACT
The purpose of this study was to investigate the risk of the patient having: (1) TB, (2) sarcoidosis, (3) atypical mycobacteria, or (4) malignant disease, if FNAC or histology from a cervical lymph node shows granulomatous inflammation (GI). And to elucidate clinical characteristics associated with these causes of GI, patients with a pathological diagnosis of GI in head and neck lymph nodes were identified though a search of the Danish national pathology database. Charts were reviewed to identify the final clinical diagnosis and specific clinical characteristics. For the most common clinical diagnoses, association to clinical characteristics was analyzed using logistic regression (Odense University Hospital January 2006 to December 2015). We included 121 patients. Clinical diagnoses fell into the following categories: sarcoidosis (26%), tuberculosis (TB) (22%), cat scratch disease (6%), atypical mycobacteriosis (7%), malignancy (2%), and other (4%). In 33% of cases, the diagnosis was unknown. In the pediatric group, atypical mycobacteriosis was the most frequent clinical diagnosis (50%). TB and sarcoidosis were dependent variables in regression analysis. Characteristics significantly related to TB were histology showing necrotizing GI, gland localization in level 3-6, and origin other than Danish and TB being the tentative diagnosis. Characteristics significantly related to sarcoidosis were histology showing non-necrotizing GI, gland localization in level 3-6, the patient being of Danish origin, and unknown duration of symptoms. TB and sarcoidosis were the most common clinical diagnoses, and they were associated with specific clinical characteristics. In a third of cases, a specific clinical diagnosis was never given.
Subject(s)
Granuloma/epidemiology , Lymph Nodes/pathology , Lymphadenitis/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy , Cat-Scratch Disease , Child , Child, Preschool , Denmark/epidemiology , Female , Granuloma/immunology , Granuloma/microbiology , Granuloma/pathology , Head , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/immunology , Head and Neck Neoplasms/pathology , Humans , Incidence , Infant , Lymph Nodes/immunology , Lymph Nodes/microbiology , Lymphadenitis/immunology , Lymphadenitis/microbiology , Lymphadenitis/pathology , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/complications , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/immunology , Mycobacterium Infections, Nontuberculous/microbiology , Neck , Nontuberculous Mycobacteria/isolation & purification , Retrospective Studies , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Sarcoidosis/complications , Sarcoidosis/epidemiology , Sarcoidosis/immunology , Tuberculosis/complications , Tuberculosis/epidemiology , Tuberculosis/immunology , Tuberculosis/microbiology , Young AdultABSTRACT
This is a case report of a 30-year-old female, who presented to the emergency department with headache, nausea and neck pain after five days of otitis media. After lumbar puncture, CT and MRI the patient was treated for meningitis with initial improvement in the clinical state. After four days she developed contralateral neurological symptoms, and after five days she had a seizure. MR-venography showed thrombosis of the lateral dural sinus with venous cerebral infarction. The treatment of intravenously administered antibiotics, mastoidectomy and anticoagulation is discussed and compared with other cases in the literature.
