Tuberculous mediastinal lymphadenopathy in adults

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Mediastinal lymphadenopathy presents a diagnostic challenge, often requiring differentiation between infectious, inflammatory, and neoplastic causes.
• Common differentials for paratracheal and hilar lymph node enlargement include sarcoidosis, lymphoma, and metastatic disease.
• Tuberculous lymphadenitis is a known extrapulmonary manifestation of tuberculosis, but its presentation without parenchymal lung lesions is less common in adults.

Observation:

• Three adult cases presented with paratracheal and hilar lymph node enlargement.
• These cases initially mimicked sarcoidosis, lymphoma, and metastasis due to the absence of parenchymal lung lesions.
• Diagnostic imaging revealed significant mediastinal lymphadenopathy.

Findings:

• Histopathological examination confirmed tuberculous lymphadenitis as the underlying cause in all three cases.
• The findings highlight a rare but significant presentation of tuberculosis.
• No parenchymal lung lesions were observed in these patients.

Implications:

• Tuberculous lymphadenitis should be considered in the differential diagnosis of mediastinal lymphadenopathy, even in the absence of pulmonary involvement.
• Increased awareness is particularly important for non-white populations where tuberculosis prevalence may be higher.
• This underscores the need for comprehensive diagnostic workups to avoid misdiagnosis and ensure appropriate treatment for tuberculous lymphadenitis.