An Atypical Presentation of Tuberculosis Lymphadenitis

Tuberculosis (TB), one of the oldest diseases of human, remains a global health problem especially in developing countries. Tuberculosis is classified as pulmonary or extrapulmonary. Tuberculosis lymphadenitis is the most common form of extrapulmonary TB. In this report, we present a patient with TB lymphadenitis who had atypical multiple lymph node involvement similar to malignancies without symptoms of lung disease. An 81-year-old male presented with a 3-month history of a growing swelling in the cervical region. In the month prior to presentation another swelling developed in the right axillary region. Physical examination revealed multiple lymphadenopathies in the cervical and axillary regions. A computerized tomography revealed lymphadenopathy at right axillary region 5 x 2 cm in diameter, a cystic mass or abscess at right posterior cervical region 3 x 2 cm in diameter and multiple lymphadenopathies in the cervical regions. Thoracic tomography revealed fibro-atelectasis, thick fibrotic bands and increased reticulonodular density in both lungs which were reported as reactivation of TB. An excisional biopsy was performed which revealed granulomatous inflammatory process with caseous necrosis. Acid-resistant bacteria were detected from microbiological assessment of both the pus of the mass and the nodular lesion via polymerase chain reaction. The diagnosis was reactivated TB lymphadenitis. Although multiple lymphadenopathies accompanied with weight loss suggest malignancies, TB must also be considered in the differential diagnosis.