Chest tuberculosis with mediastinal asymptomatic lymphadenitis without lung involvement in an immunocompetent patient

Abstract

Tuberculosis remains the major cause of morbidity and mortality by a single infectious agent, particularly in developing countries. In recent years, we have witnessed the emergence of uncommon radiographic patterns of chest tuberculosis. Lymphadenitis is the most common extrapulmonary tuberculosis (TB) manifestation which, in developed countries, occurs more frequently in childhood, but also among adult immigrants from endemic countries and in HIV-infected people. Isolated and asymptomatic mediastinal lymphadenitis is uncommon in immunocompetent adults. We report a case of a young adult man from Senegal affected by sovraclavear and mediastinal TB lymphadenitis, which contains some uncommon elements: no compromised immunity, especially no HIV-infection, no lung lesions, no symptoms of infection or of mediastinum involvement, and rapid response to therapy in terms of mass size reduction. Examination of extra-thoracic lymph nodes and the patient's characteristics guided our diagnostic process to suspect TB. Surgical biopsy and subsequent histopathological and microbiological examinations of lymph material, first by Lowestein-Jensen and BACTEC cultures that remain the gold standard of diagnosis, confirmed the diagnosis. Chest X-ray was inconclusive; however, CT played an important role in the diagnostic course and in the management of the patient, particularly in determining disease activity, offering mediastinum and parenchymal details, as well as in identifying typical features of tuberculous lymph nodes and also of active/non active disease. Six months of antimycobacterial regimen is the recommended treatment in TB lymphadenitis of HIV-negative adults.

The differential diagnostic role of pet-CT in sarcoidosis and lymphoma

“…Pulmonary findings are predominantly found in adult tuberculosis patients and diagnosed with microbiologic methods regardless of biopsy in general [9,10]. In our 9-years' experience, we only encountered 9 adult patients with tuberculosis depended MLAP.…”

Standerd cervical mediastinoscopy in the diagnosis of mediastinal mass in Ghazi Al-Hariri Hospital

“…In group II of our study in patients with isolated lymphadenopathy TB lymphadenitis was the commonest diagnosis (4 cases) which considered a big number in comparison to other studies. (6,14,15)in their series reported only 4 cases with TB lymphadenitis from 240 consecutive cases. This is because of rising incidence of TB in our country.…”

Puesta al día en el estudio radiológico de la tuberculosis pulmonar

“…En la afectación adenopática por tuberculosis primaria, la localización hiliar y la paratraqueal derecha son las más comunes 25 (fig. 3).…”

“…No obstante, en un tercio de los casos se pueden observar de forma bilateral 19 . Las adenopatías mayores de 2 cm de diámetro generalmente muestran, en la TC, un centro hipodenso secundario a la caseificación, lo que sugiere la presencia de enfermedad activa 10,25 .…”