A 25-year-old male presents with persistent fever, weight loss, and swelling in the neck. On examination, he has enlarged, firm, non-tender lymph nodes in the cervical region. The patient also reports a history of night sweats. Given the suspicion of tuberculous lymphadenitis (T.B. lymphadenitis), which of the following findings is most commonly associated with this condition?
A. Calcified nodes are usually seen on plain X-ray abdomen
B. Features of intestinal obstruction are present
C. It is easy to differentiate from acute appendicitis
D. Lymphocytosis is seen in most cases
E. The nodes are always palpable
Correct Answer:
D. Lymphocytosis is seen in most cases
Explanation:
Tuberculous lymphadenitis (T.B. lymphadenitis) is a common presentation of extrapulmonary tuberculosis, especially in developing countries. It typically involves the cervical lymph nodes but can affect other lymphatic regions as well. This condition is caused by Mycobacterium tuberculosis, and it leads to chronic lymph node enlargement that can present with a range of symptoms, including fever, night sweats, and weight loss.
Why “D. Lymphocytosis is seen in most cases” is the Correct Answer:
- Lymphocytosis is the most common finding in the blood of patients with tuberculous lymphadenitis. This occurs because of the body’s immune response to the chronic infection. In response to the tuberculosis infection, there is an increase in lymphocytes (a type of white blood cell) that helps fight off the infection.
- Other Blood Findings: In some cases, patients with T.B. lymphadenitis may also have an elevated erythrocyte sedimentation rate (ESR) and positive tuberculin skin test (TST). The diagnosis is typically confirmed by biopsy of the affected lymph node or through culture for Mycobacterium tuberculosis.
- Histopathology of lymph nodes in T.B. lymphadenitis typically shows granulomatous inflammation, which is characteristic of tuberculosis infections.
Analysis of Other Options:
A. Calcified nodes are usually seen on plain X-ray abdomen:
- This statement is incorrect. Calcified lymph nodes may be seen in patients with chronic tuberculosis and are more likely to be identified in chest X-rays rather than the abdominal X-ray. While calcification is a feature of healed or chronic tuberculous lymphadenitis, it is not typically the first imaging finding, especially in the initial stages of the disease. An X-ray abdomen is not typically used to assess for T.B. lymphadenitis.
B. Features of intestinal obstruction are present:
- This statement is incorrect. T.B. lymphadenitis primarily affects the lymph nodes and does not typically cause intestinal obstruction. However, intestinal tuberculosis can lead to obstruction in severe cases. It is important to differentiate between lymph node involvement (as seen in T.B. lymphadenitis) and intestinal tuberculosis, which may have features like abdominal pain and obstruction due to mesenteric lymphadenitis or involvement of the intestines.
C. It is easy to differentiate from acute appendicitis:
- This statement is incorrect. Differentiating tuberculous lymphadenitis from acute appendicitis can be challenging in some cases, especially when the lymphadenitis affects the mesenteric lymph nodes and mimics symptoms of abdominal pain and right lower quadrant tenderness. Diagnostic imaging, such as ultrasound or CT scans, and a thorough clinical workup are necessary to make an accurate diagnosis.
E. The nodes are always palpable:
- This statement is incorrect. While cervical lymphadenopathy (swelling of the lymph nodes in the neck) is common in tuberculous lymphadenitis, it is not always palpable, especially in deep lymph nodes or early stages of the disease. The nodes may be deep-seated or small, making them difficult to feel on physical examination. Non-palpable lymph nodes can still be involved in tuberculous infection.
Key Points to Remember:
- Lymphocytosis is commonly seen in tuberculous lymphadenitis due to the immune response to the chronic infection.
- Calcification of lymph nodes may occur in chronic tuberculosis but is not typically seen in the early stages.
- Features of intestinal obstruction are not typically associated with tuberculous lymphadenitis, although intestinal tuberculosis can cause obstruction.
- Differentiating T.B. lymphadenitis from acute appendicitis can be challenging, especially in cases where mesenteric lymph nodes are involved.
- The lymph nodes in T.B. lymphadenitis are not always palpable, especially if they are deep within the body or in the early stages of the disease.
Clinical Management:
- Diagnosis of T.B. lymphadenitis is confirmed by biopsy of the affected lymph node, which typically shows granulomatous inflammation.
- Antituberculous therapy (e.g., rifampicin, isoniazid, ethambutol, and pyrazinamide) is the cornerstone of treatment for tuberculosis, including lymph node involvement.
- In some cases, drainage or surgical excision of the lymph nodes may be required if there is abscess formation or persistent symptoms.
- Follow-up is important to monitor for any signs of drug resistance or complications.
Summary:
Tuberculous lymphadenitis is a form of extrapulmonary tuberculosis characterized by chronic lymph node enlargement, commonly in the cervical region. Lymphocytosis is the most common blood finding in this condition. The condition may present with fever, night sweats, and weight loss. Calcified nodes may appear in chronic cases, but they are not typically seen in the early stages of the disease. Early diagnosis through biopsy and appropriate antituberculous treatment are essential for managing this condition.