title: Chest tuberculosis with mediastinal asymptomatic lymphadenitis without lung involvement in an immunocompetent patient.
abstract: Tuberculosis remains the major cause of morbidity and mortality by a single infectious agent, particularly in developing countries. In recent years, we have witnessed the emergence of uncommon radiographic patterns of chest tuberculosis. Lymphadenitis is the most common extrapulmonary tuberculosis (TB) manifestation which, in developed countries, occurs more frequently in childhood, but also among adult immigrants from endemic countries and in HIV-infected people. Isolated and asymptomatic mediastinal lymphadenitis is uncommon in immunocompetent adults. We report a case of a young adult man from Senegal affected by sovraclavear and mediastinal TB lymphadenitis, which contains some uncommon elements: no compromised immunity, especially no HIV-infection, no lung lesions, no symptoms of infection or of mediastinum involvement, and rapid response to therapy in terms of mass size reduction. Examination of extra-thoracic lymph nodes and the patient's characteristics guided our diagnostic process to suspect TB. Surgical biopsy and subsequent histopathological and microbiological examinations of lymph material, first by Lowestein-Jensen and BACTEC cultures that remain the gold standard of diagnosis, confirmed the diagnosis. Chest X-ray was inconclusive; however, CT played an important role in the diagnostic course and in the management of the patient, particularly in determining disease activity, offering mediastinum and parenchymal details, as well as in identifying typical features of tuberculous lymph nodes and also of active/non active disease. Six months of antimycobacterial regimen is the recommended treatment in TB lymphadenitis of HIV-negative adults.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Sassari, Sassari Italy. pirina@uniss.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Pirina
authors.forename: Valentina
authors.initials: V
authors.lastname: Spada
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoru
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Polo
authors.forename: Paola
authors.initials: P
authors.lastname: Molicotti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Marras
authors.forename: Paolo
authors.initials: P
authors.lastname: Cossu Rocca
authors.forename: Sara
authors.initials: S
authors.lastname: Canu
authors.forename: Stefania
authors.initials: S
authors.lastname: Zanetti
authors.forename: Alessandro Giuseppe
authors.initials: AG
authors.lastname: Fois
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage; D001431:Bacteriological Techniques; D001706:Biopsy; D006651:Histocytochemistry; D006801:Humans; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D013902:Radiography, Thoracic; D012675:Senegal; D013909:Thorax / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000995:Antitubercular Agents