A Granulomatous Puzzle: Tubercular Lymphadenitis Without AFB Clues

Area of Science:

• Medicine
• Infectious Diseases
• Oncology

Background:

• Tubercular lymphadenitis (TBL) is the most frequent extrapulmonary tuberculosis (EPTB) manifestation, comprising 20%-40% of cases.
• Atypical presentations of TBL in the head and neck can mimic other serious conditions, posing diagnostic challenges.

Purpose of the Study:

• To report a case of TBL with an unusual presentation in the head and neck region.
• To highlight the diagnostic utility of Fine Needle Aspiration Cytology (FNAC) in TBL, especially when conventional tests are negative.

Main Methods:

• Case presentation of a 45-year-old male with a progressive jaw swelling.
• Diagnostic workup included initial misdiagnosis of malignancy, followed by histopathological examination (HPE), FNAC, Acid-Fast Bacilli (AFB) staining, and Gene Xpert testing.
• Treatment involved a 2-month antitubercular regimen.

Main Results:

• Initial consultation suggested carcinoma; HPE revealed a tubercular granulomatous lesion.
• FNAC indicated TBL, but AFB stain and Gene Xpert were negative for Mycobacterium tuberculosis.
• The patient showed significant improvement with a 2-month antitubercular drug regimen.

Conclusions:

• Atypical TBL presentations in the head and neck require a high index of suspicion.
• FNAC is a valuable, rapid, and minimally invasive tool for diagnosing TBL, even with negative results from AFB stain and Gene Xpert.
• Early diagnosis and treatment of TBL are crucial for favorable patient outcomes.