Quiz of the week Presented by Abdulaziz alraqtan

This image shows a 31 Y/O saudi male who presented with neck swelling, significant weight loss and fever for two months. The swelling was painless. The Pt has dry cough and denied hemoptysis.

1- Describe the findings. 2- What questions would you like to ask the patient? 3- What is your diagnosis? 4- How will you manage the patient?

Cervical lymph nodes

TB cervical lymphadenitis Tuberculous lymphadenitis in the cervical region is known as scrofula. It has been postulated that cervical tuberculous lymphadenitis occurs as a result of TB infection involving the tonsils, adenoids, and Waldeyer's ring, leading to cervical lymphadenopathy Cervical lymphadenopathy is the most common manifestation of tuberculous lymphadenitis

Most frequently, a unilateral mass appears in the anterior or posterior cervical triangles; submandibular and supraclavicular lymph node involvement also occurs. Bilateral disease is uncommon. Tuberculous cervical lymphadenitis can be complicated by ulceration, fistula, or abscess formation.

differential diagnosis includes Malignancy (eg, Hodgkin lymphoma and non-Hodgkin lymphoma) Other infections (eg, nontuberculous mycobacteria), Cat scratch disease, Fungal infection, Sarcoidosis, Kikuchi's disease can cause a necrotizing lymphadenitis and mimic tuberculosis (TB) cervical lymphadenopathy

DIAGNOSIS Established by histopathology examination along with acid-fast bacilli (AFB) smear and culture of lymph node material. Chest imaging should also be obtained

TREATMENT Treatment of tuberculous lymphadenitis consists of antimycobacterial therapy two months of rifampicin, isoniazid,ethambutol, and pyrazinamide (given daily) followed by four months of rifampicin and isoniazid (given either daily or three times weekly)

Thank you