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A 34-Year-Old Man With a Neck Mass
Tamara Phiri1, Joep van Oosterhout1, Samuel Kampondeni1
1Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
Chest
|March 8, 2022
Summary
A man with enlarged lymph nodes tested HIV positive. Diagnostic limitations in Malawi hindered confirming the cause of his condition, leading to loss to follow-up.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Public Health
Background:
- Cervical lymphadenopathy is a common clinical presentation in resource-limited settings.
- Human Immunodeficiency Virus (HIV) infection can present with or be complicated by lymphadenopathy.
- Diagnostic challenges in low-resource settings can impede timely and accurate etiological diagnosis.
Observation:
- A 34-year-old male presented with enlarged cervical lymph nodes in Malawi.
- Initial fine-needle aspiration (FNA) for acid-fast bacilli (AFB) was negative.
- The patient was HIV-positive, but further workup was pending.
Findings:
- Limited diagnostic capabilities, including lack of mycobacterial culture and Xpert MTB/RIF, hindered etiological diagnosis.
- The patient was lost to follow-up before planned lymph node excision biopsy.
- The definitive cause of lymphadenopathy remained unconfirmed.
Implications:
- Highlights the challenges in diagnosing lymphadenopathy in HIV-positive individuals in resource-limited settings.
- Underscores the need for improved diagnostic infrastructure and accessibility for mycobacterial infections.
- Emphasizes the impact of diagnostic delays and loss to follow-up on patient management and outcomes.
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