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Tuberculous hilar lymphadenopathy progressing after isoniazid administration
1Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 5-8-31 Agenogi, Matsue, Shimane 690-8556, Japan. yano@matsue.hosp.go.jp
Summary
Hilar lymphadenopathy can indicate tuberculosis (TB) in immunocompetent individuals, even without detectable Mycobacterium tuberculosis. Monotherapy with isoniazid may worsen TB lesions, highlighting the need for comprehensive diagnosis.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Tuberculosis (TB) diagnosis typically relies on detecting Mycobacterium tuberculosis organisms.
- Hilar lymphadenopathy can be an isolated finding in TB, particularly in immunocompetent patients.
Observation:
- A 19-year-old immunocompetent male presented with right hilar lymphadenopathy and a positive whole blood interferon-gamma assay (QuantiFERON-TB Gold).
- Initial chest radiography did not reveal the lung lesion, leading to isoniazid (INH) monotherapy.
- The patient experienced progression of hilar lymphadenopathy during INH monotherapy.
Findings:
- Hilar lymphadenopathy can be the sole radiologic manifestation of tuberculosis.
- Inadequate treatment, such as isoniazid monotherapy, can lead to disease progression in TB patients.
- Tuberculosis should be considered even when Mycobacterium tuberculosis is not readily detected.
Implications:
- Clinicians must consider tuberculosis in cases of unexplained hilar lymphadenopathy, even with negative sputum microscopy.
- Prompt and appropriate anti-TB treatment is crucial to prevent disease progression.
- Diagnostic delays and monotherapy can adversely affect TB patient outcomes.
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