Cervical Lymphadenopathy in a Nonagenarian Woman: What to Think?

  • Vanessa Meireles Chaves Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Fernando Nogueira Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Gilberto Pires da Rosa Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Sofia Tavares Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Inês Ferreira Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Ana Oliveira Monteiro Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Ester Ferreira Department of Internal Medicine, Centro Hospitalar Universitário de S. João, Porto, Portugal

Keywords

Cervical lymphadenopathy, cervical tuberculous lymphadenitis, fine needle aspiration biopsy, excisional biopsy, differential diagnosis

Abstract

Tuberculosis remains a worldwide public health problem. Cervical tuberculous lymphadenitis (TBL) or scrofula is the most common form of extrapulmonary tuberculosis, affecting the cervical lymph nodes. We report the case of a 93-year-old woman presenting with cervical adenopathies with 3 months duration. Fine needle aspiration (FNA) biopsy yielded a noncaseous granulomatous process, but was negative for Mycobacterium tuberculosis (MT). As the adenopathies had grown, an excisional biopsy was performed. An extensive study of infectious aetiologies was performed, including for MT, with a negative outcome. Owing to the persistence of cervical lymphadenitis with caseous granulomas, a diagnosis of TBL was strongly suspected and presumptive treatment was initiated. Afterwards, diagnostic confirmation was obtained by isolation of MT in the lymph node culture. The patient presented a favourable clinical outcome. This case highlights that a high index of suspicion is essential for the diagnosis of TBL, especially in the elderly, and emphasizes the importance of pursuing diagnostic confirmation, in which FNA and excisional biopsy plays a key role.

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References

  • Rito T, Matos C, Carvalho C, Machado H, Rodrigues G, Oliveira O, et al. A complex scenario of tuberculosis transmission is revealed through genetic and epidemiological surveys in Porto. BMC Infect Dis 2018;18:53.

  • Sotgiu G, Falzon D, Hollo V, Ködmön C, Lefebvre N, Dadu A, et al. Determinants of site of tuberculosis disease: an analysis of European surveillance data from 2003 to 2014. PLoS One 2017;12:e0186499.

  • Cataño JC, Robledo J. Tuberculous lymphadenitis and parotitis. Microbiol Spectr 2016;4(6):TNMI7-0008-2016.

  • Moualed D, Robinson M, Qureishi A, Gurr P. Cervical tuberculous lymphadenitis: diagnosis and demographics, a five-year case series in the UK. Ann R Coll Surg Engl 2018;100:392–396.

  • Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J; International Atomic Energy Agency Extra-pulmonary TB Consortium. Imaging in extrapulmonary tuberculosis. Int J Infect Dis 2017;56:237–247.
  • Published: 2019-12-03

    Issue: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    Chaves, V., Nogueira, F., Pires da Rosa, G., Tavares, S., Ferreira, I., Oliveira Monteiro, A., & Ferreira, E. (2019). Cervical Lymphadenopathy in a Nonagenarian Woman: What to Think?. European Journal of Case Reports in Internal Medicine, 2. https://doi.org/https://doi.org/10.12890/2019_001336