European Journal of Biomedical and Pharmaceutical Sciences

TUBERCULOUS CERVICAL LYMPHADENITIS, THE “DANGEROUS MASQUERADER”: ANOTHER UNUSUAL PRESENTATION

Adedayo O. Olaosun*, Samuel S. Taiwo, Peter B. Olaitan, Olawale Ogundiran, Moroof O. A. Gbadamosi, Adekola O Adekunle., Adetoun A. Popoola, Olaejirinde O. Olaofe., Taiwo O. Solaja, Victor O. Oyedepo, Segun S. Akindokun, Oluwatoyin N. Akinyoade, Oluwafunmilayo A. Olaosun, Titilayo A. Ajayeoba

ABSTRACT

Tuberculous Cervical Lymphadenitis is the most common manifestation of extra-pulmonary tuberculosis. The disease has been known since antiquity and normally presents with neck masses. It has been referred to as ―the great masquerader‖ as it is known to mimic several other pathologies, often constituting a diagnostic challenge. We report a patient who presented early but uncharacteristically with an acute febrile illness and initially without a neck mass. He proceeded to develop painful bilateral neck masses which assumed appreciable proportions in only a couple of weeks, thus mimicking an acute inflammatory neck mass. Tuberculosis was suspected early, but diagnosis could not be confirmed as the initial laboratory investigations (tuberculin skin test, staining for Acid Fast Bacilli and Fine Needle Aspiration Cytology) could not confirm the diagnosis. Since there was a high index of suspicion, however, the patient was eventually placed on a therapeutic trial of anti-tuberculosis medication. Diagnosis was later confirmed with a culture of Mycobacterium tuberculosis and treatment for extra-pulmonary tuberculosis was completed. The response was dramatic and the lesion resolved completely without need for further surgical intervention. This case emphasizes the need for openness to unusual modes of presentation, a sustained high index of suspicion, thorough evaluation and the need for a multidisciplinary approach in the diagnosis and management of tuberculous cervical lymphadenitis.

Keywords: Tuberculosis, Cervical Lymphadenopathy, Tuberculous Lymphadenitis, Scrofula.