Left Lateral Cervical Mass with Draining Sinuses

Area of Science:

• Medicine
• Infectious Diseases
• Pulmonology

Background:

• Tuberculous lymphadenitis (TL) is a common form of extrapulmonary tuberculosis.
• Cervical lymphadenopathy is an unusual presentation in elderly patients.

Observation:

• An 89-year-old male smoker presented with asymptomatic left lateral cervical swelling and draining sinuses.
• Elevated ESR and a calcified nodule on chest CT were noted; other clinical findings were absent.

Findings:

• Pus samples and lymph node pathology confirmed tuberculosis.
• The patient experienced an initial remission followed by exacerbation, necessitating oral steroids.
• Paradoxical reactions during treatment can occur in symptomless TL.

Implications:

• This case highlights the importance of considering TL in elderly patients with atypical presentations.
• The use of oral steroids to manage clinical deterioration in TL is demonstrated.
• Complete recovery was achieved with standard antituberculous chemotherapy.