|Year : 2015 | Volume
| Issue : 2 | Page : 126-128
Tuberculous cervical lymphadenitis
Nandhini Gunasekaran1, Rajkumar Krishnan1, Krishna Kumar Raja2, Annasamy Ramesh Kumar1
1 Department of Oral Pathology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
|Date of Web Publication||20-Apr-2015|
Department of Oral Pathology, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
Tuberculous lymphadenitis occurring in the cervical region is the most common cause of extra-pulmonary tuberculosis (TB). Isolated form of tuberculous cervical lymphadenitis is rare and is described in patients without evidence of previous or ongoing TB anywhere in the body. This type yields inconsistent physical and laboratory findings, and final diagnosis requires biopsy. In this article, we report a case of tuberculous cervical lymphadenitis in a 24-year-old female patient with no evidence of TB elsewhere and diagnosis was based on histopathology.
Keywords: Caseating granuloma, cervical lymph node/ lymphadenitis, tuberculosis
|How to cite this article:|
Gunasekaran N, Krishnan R, Raja KK, Kumar AR. Tuberculous cervical lymphadenitis. SRM J Res Dent Sci 2015;6:126-8
| Introduction|| |
Tuberculous cervical lymphadenitis is the most frequent extra-pulmonary manifestation of tuberculosis (TB). It is also known as scrofula and is caused by tuberculous and nontuberculous mycobacteria. Clinically it presents as a painless, unilateral, slow growing mass in a single group of nodes, and is mostly located in the posterior cervical lymph node.
Isolated cervical tuberculous lymphadenitis is usually rare and is seen patients without previous or active pulmonary TB and with no evidence of origin of TB anywhere. It can be a manifestation of a systemic disease or primary disease in the neck. Diagnosis is difficult in such cases and requires confirmation by biopsy.
We herewith report a case of tuberculous cervical lymphadenitis in a healthy 24-year-old female with no evidence of previous or active pulmonary TB.
| Case report|| |
A 24-year-old female reported to the Oral Medicine Department with a complaint of swelling and pain in lower part of the neck region for past 1 month. History revealed that the swelling was initially small in size and gradually increased in size and was associated with pain.
Clinical examination revealed a single well circumscribed smooth surfaced swelling in the right lower part of the neck near the lower end of the posterior border of sternomastoid muscle, measuring 2.5 cm × 3 cm in size. Palpation revealed that the swelling was firm in consistency, movable and was tender [Figure 1].
Routine blood investigations revealed no abnormality in any of the parameters. HIV 1 and HIV 2 screening was negative. Chest X-ray showed clear lung fields, and fine-needle aspiration cytology (FNAC) was found to be indeterminate. A clinical diagnosis of cervical lymphadenopathy was given.
Under local anesthesia, the swelling was surgically excised [Figure 2] and the biopsied tissue was fixed in 10% formalin, and sent for histopathologic examination [Figure 3].
The microscopic examination of the hematoxylin and eosin stained section revealed lymph node with proliferated germinal follicles surrounded by lymphocytes, histiocytes and plasma cells [Figure 4]. At areas of caseous necrosis, Langhan's type of giant cells was also seen surrounded by epitheloid cell aggregates [Figure 5] and [Figure 6].
|Figure 5: Caseous necrosis with Langhan's type of giant cells (H and E, ×10)|
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|Figure 6: Langhan giant cell surrounded by epitheloid cells (H and E, ×40)|
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The tissue sections were also stained with Ziehl-Neelsen stain and it revealed positivity for acid-fast bacilli (AFB) indicating the presence of Mycobacterium tuberculosis.
Based on the histopathological findings the swelling was diagnosed as tuberculous cervical lymphadenitis.
The patient was referred to Government TB sanatorium for further treatment and the treatment consisted of anti-TB drugs for a period of 6 months.
| Discussion|| |
Tuberculosis is a highly prevalent disease in developing country and in patients who are immunocompromised. It is caused by infection of M. tuberculosis. Extra-pulmonary TB occurs in 7-30% of all TB cases, of which tuberculous lymphadenitis accounts to about 17-43%.  The cervical lymph nodes constitute the most common site of involvement.
Tuberculous cervical lymphadenitis is also called as scrofula and is commonly seen in children and young adults between the ages of 11-30 years. It is also seen in immunocompromised individuals, especially those with HIV. 
It may occur during primary tuberculous infection or as a result of reactivation of dormant foci or direct extension from a contiguous focus.  Clinically it presents with chonic, painless mass in the neck, which is persistent and usually grows with time and is usually accompanied by fever, chills, malaise and weight loss.
For the early diagnosis and treatment of tuberculous cervical lymphadenitis, a thorough history and physical examination, tuberculin test, staining for AFB, radiologic examination and FNAC should be done. Final diagnosis can be made by both incisional or excisional biopsy and culture. ,
Histopathology is diagnostic and consists of caseating tubercle/granuloma, composed of Langhan giant cells, surrounded by epithelioid cell aggregates, T cell lymphocytes and fibroblasts.
Tuberculous cervical lymphadenitis is best treated with anti-TB medication and, in addition, surgical treatment is more useful in selected cases.
In our case, the systemic signs and symptoms of TB were absent, and the blood investigations and FNAC were inconclusive, and hence the diagnosis was difficult to arrive at, and final, conclusive diagnosis was based on the histopathology of the excised lesion.
| Conclusion|| |
Diagnosis of the isolated tuberculous cervical lymphadenitis is very crucial in the initial stages and would be beneficial to the patient to receive early treatment, and also to prevent spreading of the disease to others.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]