Print this page Email this page | Users Online: 29
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 6  |  Issue : 2  |  Page : 126-128

Tuberculous cervical lymphadenitis


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 Publication20-Apr-2015

Correspondence Address:
Nandhini Gunasekaran
Department of Oral Pathology, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
India
Login to access the Email id


DOI: 10.4103/0976-433X.155476

Rights and Permissions
  Abstract 

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

How to cite this URL:
Gunasekaran N, Krishnan R, Raja KK, Kumar AR. Tuberculous cervical lymphadenitis. SRM J Res Dent Sci [serial online] 2015 [cited 2020 Oct 28];6:126-8. Available from: https://www.srmjrds.in/text.asp?2015/6/2/126/155476


  Introduction Top


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 Top


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].
Figure 1: Well circumscribed swelling in the neck

Click here to view


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].
Figure 2: Surgically exposed lesion

Click here to view
Figure 3: Excised specimen

Click here to view


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 4: Chronic granulomatous inflammation (H and E, ×4)

Click here to view
Figure 5: Caseous necrosis with Langhan's type of giant cells (H and E, ×10)

Click here to view
Figure 6: Langhan giant cell surrounded by epitheloid cells (H and E, ×40)

Click here to view


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 Top


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%. [1] 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. [2]

It may occur during primary tuberculous infection or as a result of reactivation of dormant foci or direct extension from a contiguous focus. [3] 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. [4],[5]

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 Top


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 Top

1.
Porto L, Filho IC, Ramalho E, Miranda J, Leal M, Travassos N. Axillary tuberculous lymphadenitis: A case report and a literature review. J Senologic Int Soc 2012;1.   Back to cited text no. 1
    
2.
Jha BC, Dass A, Nagarkar NM, Gupta R, Singhal S. Cervical tuberculous lymphadenopathy: Changing clinical pattern and concepts in management. Postgrad Med J 2001;77:185-7.  Back to cited text no. 2
    
3.
Mohapatra PR, Janmeja AK. Tuberculous lymphadenitis. J Assoc Physicians India 2009;57:585-90.  Back to cited text no. 3
    
4.
Ibekwe AO, al Shareef Z, al Kindy S. Diagnostic problems of tuberculous cervical adenitis (scrofula). Am J Otolaryngol 1997;18:202-5.  Back to cited text no. 4
    
5.
Albright JT, Pransky SM. Nontuberculous mycobacterial infections of the head and neck. Pediatr Clin North Am 2003;50:503-14.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed6816    
    Printed34    
    Emailed0    
    PDF Downloaded301    
    Comments [Add]    

Recommend this journal