Mediastinal tuberculous lymphadenitis presenting with insidious back pain in a male adult: a case report and review of the literature

Xpert MTB/RIF assay for the differential diagnosis between sarcoidosis and tuberculosis intrathoracic lymphadenopathy

BACKGROUND

The aim of this study was to evaluate the role of Xpert MTB/RIF assay in the detection of Mycobacterium tuberculosis for differentiating tuberculosis intrathoracic lymphadenopathy from sarcoidosis intrathoracic lymphadenopathy.

METHODS

The patients who were suspected to having sarcoidosis or tuberculosis intrathoracic lymphadenopathy at the Shanghai Pulmonary Hospital between October 1, 2020 and June 30, 2021 were retrospectively evaluated in this study. All patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and Xpert analysis. Differences in clinical and radiological features were recorded. The diagnostic performances of EBUS-TBNA Xpert, acid-fast bacilli, culture, and peripheral blood QuantiFERON-TB Gold (QFT) for differentiating sarcoidosis from tuberculosis intrathoracic lymphadenopathy were analyzed.

RESULTS

A total of 119 patients were included in this analysis. Of those, 83 patients were finally diagnosed with sarcoidosis (N = 50) and tuberculosis (N = 33) intrathoracic lymphadenopathy. Young individuals were more likely to have tuberculosis versus sarcoidosis intrathoracic lymphadenopathy (P = 0.006). Markers of inflammation, including fever, leukocytes, and serum ferritin levels, were significantly higher in tuberculosis versus sarcoidosis intrathoracic lymphadenopathy (P < 0.01). Bilateral lung involvement and symmetry intrathoracic lymphadenopathy were more common in sarcoidosis intrathoracic lymphadenopathy (P < 0.01). In addition, the longest diameter of intrathoracic lymphadenopathy (in cm) was significantly larger in sarcoidosis intrathoracic lymphadenopathy (P = 0.001). However, the largest diameter of lung lesions was significantly shorter (P = 0.005). The sensitivity and specificity values of Xpert and QFT for differentiating these two diseases were 69.70% and 100%, and 96.43% and 91.84%, respectively.

CONCLUSION

Xpert MTB/RIF is recommended for the diagnosis of tuberculosis intrathoracic lymphadenopathy using EBUS-TBNA samples. A negative QFT suggests the exclusion of the diagnosis of tuberculosis intrathoracic lymphadenopathy.

Isolated humeral tuberculosis lymphadenitis in healthy woman: Case report

Introduction

Pulmonary tuberculosis is a disease that may effect on many organs such as the lung, peritoneum and spread to adjacent lymph nodes in advanced stages, but it is rarely to be as an isolated lymph node without accompanying pulmonary or extra pulmonary tuberculosis in healthy persons.

Case presentation

A 40 –Years-female presented with a chief complaint of Pain in the lateral side of the Right humerus above the elbow, with no medical history, on clinical examination there was a painful palpable mass in mentioned place. The mass was removed surgically under local anesthesia and sent for pathological autopsy. The result of the pathological autopsy was tuberculosis lymphadenitis. After that, the patient has been sent to a specialized center for tuberculosis to receive the suitable treatment.

Discussion

More studies should be done to investigate the potential causes of these unusual cases and finding the accurate physiological mechanisms that inhibit the usual manifestations of tuberculosis in these patients to avoid advanced complications.

Conclusion

Isolated tuberculosis lymphadenitis in healthy persons is unusual case in the literature, which the clinical doctors should be careful in examination the patients who admitting with abnormal lymph nodes and unknown history exposure to tuberculosis. .

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Tuberculous Lymphadenitis is one of the most common accompaniments of pulmonary Tuberculosis.

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Clinical doctors may pay attention to perform an accurate examination for observed isolated nodes even in healthy people.