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An unusual presentation of extrapulmonary tuberculosis
Sumitra Basuthakur1, Susmita Kundu, Pulak Kumar Jana
1RG Kar Medical College and Hospital, Kolkata 700004.
Journal of the Indian Medical Association
|February 28, 2006
Summary
A young female with fever and respiratory issues presented with a postauricular lump. Diagnosis revealed tuberculosis (TB) infection, successfully treated with chemotherapy.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Immunology
Background:
- Tuberculosis (TB) can present with atypical symptoms and extrapulmonary manifestations.
- Postauricular lymphadenopathy and systemic symptoms like fever and hepatosplenomegaly warrant thorough investigation.
Observation:
- A 22-year-old female presented with fever, respiratory distress, and a rapidly enlarging left postauricular lump.
- Clinical examination revealed anemia, a supraclavicular lymph node, and mild hepatosplenomegaly.
- Imaging showed enlarged para-aortic lymph nodes and mild pericardial effusion.
- Fine needle aspiration cytology of the lymph node indicated epithelioid cell granuloma.
Findings:
- Excision and biopsy of the postauricular lump revealed pus positive for acid-fast bacilli (AFB) on culture, despite a negative smear.
- The patient had a positive Mantoux test and normal chest X-ray, suggesting extrapulmonary TB.
Implications:
- This case highlights the importance of considering tuberculosis in the differential diagnosis of unexplained lymphadenopathy and systemic symptoms, even with a normal chest X-ray.
- Early diagnosis and appropriate antituberculous chemotherapy are crucial for favorable outcomes in extrapulmonary TB.
- AFB culture remains a gold standard for diagnosing TB, especially in smear-negative cases.