MyMedR

Fulltext Hypercalcemia in a patient with tuberculous mediastinal lymphadenopathy

Tan TT, Lee BC, Zainuddin BM, Wong KT, Samad A, Khalid BA

Singapore Med J, 1991 Feb;32(1):87-9.

PMID: 2017716

We describe the case of a 48 year old Indian female with hypercalcemia due to tuberculosis. She presented with symptoms of hypercalcemia and chest radiographs showed bilateral hilar lymphadenopathy with normal lung fields. The diagnosis of tuberculosis was made histologically from biopsy of the enlarged hilar nodes. Her hypercalcemia resolved following one month of anti-tuberculous treatment. The prevalence of hypercalcemia in tuberculosis has been reported to be high in western series. There is, however, a paucity of local data on the subject. The presence of 1-alpha-hydroxylase-like activity in pulmonary alveolar macrophages with resulting increased formation of active vitamin D metabolites is the postulated mechanism of tuberculosis associated hypercalcemia.

Matched MeSH terms: Tuberculosis, Lymph Node/complications*; Tuberculosis, Lymph Node/radiography; Tuberculosis, Lymph Node/therapy

Tuberculous lymphadenitis at Penang General Hospital, Malaysia

Khan AH, Sulaiman SA, Muttalif AR, Hassali MA, Khan TM

Med Princ Pract, 2011;20(1):80-4.

PMID: 21160220 DOI: 10.1159/000319764

To evaluate the incidence, treatment and clinical outcomes of tuberculous (TB) lymphadenitis at Penang General Hospital, Malaysia.

Matched MeSH terms: Tuberculosis, Lymph Node/diagnosis; Tuberculosis, Lymph Node/drug therapy; Tuberculosis, Lymph Node/epidemiology*

Tuberculous cervical lymphadenitis in a patient with suspected neck recurrence

Yong DJ, Iskandar H, Razif MY

Chin Med J (Engl), 2012 May;125(9):1667-8.

PMID: 22800842

The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.

Matched MeSH terms: Tuberculosis, Lymph Node/diagnosis*; Tuberculosis, Lymph Node/drug therapy

Fulltext An evidence-based clinical pathway for the diagnosis of tuberculous lymphadenitis: A systematic review

Sivaratnam L, Nawi AM, Abdul Manaf MR

Int J Mycobacteriol, 2020 6 1;9(2):107-115.

PMID: 32474531 DOI: 10.4103/ijmy.ijmy_207_19

To achieve the World Health Organization end TB Strategy, early detection, and prompt treatment of not only pulmonary but also extrapulmonary tuberculosis (EPTB) should be achieved. The most common EPTB is tuberculous lymphadenitis, and the diagnosis is typically time-consuming. This review aimed to identify the best diagnostic pathway for preventing treatment delay and thus further complications. A systematic keyword search was done using four databases and other relevant publications and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart to search for relevant articles that met the inclusion criteria. The quality of the articles was assessed using Newcastle-Ottawa Scale, and the articles were summarized based on the test for diagnosing tuberculous lymphadenitis. A total of ten articles were included for the synthesis of results, which compared the sensitivity and specificity of each diagnostic test for tuberculous lymphadenitis. The most promising test is the Xpert Mycobacterium tuberculosis/RIF, which has high sensitivity and specificity, but costs much more in comparison to the other tests. An ideal diagnostic method should include the combination of relevant patient history, clinical examination, and laboratory and radiological testing to avoid delays in treatment, misdiagnosis, and further complications.

Matched MeSH terms: Tuberculosis, Lymph Node/diagnosis*; Tuberculosis, Lymph Node/drug therapy

Factors associated with poor patient compliance with antituberculosis therapy in Northwest Perak, Malaysia

Chuah SY

Tubercle, 1991 Dec;72(4):261-4.

PMID: 1811356

A retrospective study of factors associated with poor patient compliance with antituberculosis therapy was conducted in Taiping, Perak. 219 patients were studied. Male patients and hospital referrals were significantly more likely to default. Patients with tuberculous lymphadenitis alone had a greater rate of default, but this just failed to reach significance (0.05 less than p less than 0.10). Six of 7 male hospital referrals with tuberculous lymphadenitis alone defaulted. Patients treated as outpatients from the start were more compliant. Housewives were also highly compliant. It was noticed that patients who defaulted tended to do so during early stages of treatment.

Matched MeSH terms: Tuberculosis, Lymph Node/drug therapy

Fulltext Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

Al-Halfawy A, Hussein S, Ashur W, El-Hendawi A, Hussein S

J Cardiothorac Surg, 2024 Feb 07;19(1):69.

PMID: 38326810 DOI: 10.1186/s13019-024-02560-x

BACKGROUND: Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy.

METHODS: The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure.

RESULTS: we found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis.

CONCLUSION: Lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Matched MeSH terms: Tuberculosis, Lymph Node*

Fulltext Genome sequence of Mycobacterium massiliense M18, isolated from a lymph node biopsy specimen

Ngeow YF, Wong YL, Tan JL, Arumugam R, Wong GJ, Ong CS, et al.

J Bacteriol, 2012 Aug;194(15):4125.

PMID: 22815444 DOI: 10.1128/JB.00712-12

Mycobacterium massiliense is a rapidly growing mycobacterial species. The pathogenicity of this subspecies is not well known. We report here the annotated genome sequence of M. massiliense strain M18, which was isolated from a lymph node biopsy specimen from a Malaysian patient suspected of having tuberculous cervical lymphadenitis.

Matched MeSH terms: Tuberculosis, Lymph Node/microbiology

Histopathology of lymph nodal tuberculosis--university hospital experience

Jayalakshmi P, Malik AK, Soo-Hoo HS

Malays J Pathol, 1994 Jun;16(1):43-7.

PMID: 16329575

Fifty-nine cases of tuberculous cervical lymphadenitis were analysed histologically. Characteristic epithelioid cell granulomas were seen in all the cases with central areas of caseation necrosis in 96.6% (57/59) of these cases. The diagnosis of tuberculosis was further established by the demonstration of acid-fast bacilli (AFB) in the tissue sections in 29 cases. These AFB, although occasional, were found more frequently within the epithelioid cells as compared with other zones of the granuloma. There was no significant association between necrosis and bacillary content. We conclude that light microscopical assessment is still a useful screening method to diagnose tuberculosis in cases of cervical lymphadenopathy.

Matched MeSH terms: Tuberculosis, Lymph Node/microbiology; Tuberculosis, Lymph Node/pathology

Fulltext Multi-organ involvement of tuberculosis--case report of an atypical presentation

Simon GK, Ahmad N

Med J Malaysia, 1990 Mar;45(1):78-80.

PMID: 2152074

A case involving tuberculosis of multiple organs and mimicking carcinoma in several respects is presented.

Matched MeSH terms: Tuberculosis, Lymph Node/diagnosis*; Tuberculosis, Lymph Node/drug therapy

Fulltext Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities

Khan AH, Sulaiman SAS, Laghari M, Hassali MA, Muttalif AR, Bhatti Z, et al.

BMC Infect Dis, 2019 Aug 05;19(1):691.

PMID: 31382889 DOI: 10.1186/s12879-019-4312-9

BACKGROUND: Extra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes.

METHODS: A retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes.

RESULTS: There were 1222 EPTB patients presenting 13.1% of all TB cases during 2006-2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231-1.028]; p = 0.05). On multivariate analysis, age group 56-65 years (1.658 [1.157-2.376]; p = 0.006), relapse cases (7.078 [1.585-31.613]; p = 0.010), EPTB-DM (1.773 [1.165-2.698]; p = 0.008), patients with no formal (2.266 [1.254-4.095]; p = 0.001) and secondary level of education (1.889 [1.085-3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311-1.746]; p

Matched MeSH terms: Tuberculosis, Lymph Node/drug therapy; Tuberculosis, Lymph Node/epidemiology

Fulltext Peripancreatic tuberculous lymphadenitis in an immunocompetent patient

Palaniappan S, Aizan H

Med J Malaysia, 2014 Aug;69(4):184-6.

PMID: 25500847 MyJurnal

Tuberculosis, an ancient disease continues to be a health care burden in Malaysia in the 21st century. Extrapulmonary tuberculosis is a less common presentation of tuberculosis and in particular peripancreatic tuberculous lymphadenitis is rarely seen. We report a case of a young immunocompetent boy presenting with a two month history of non productive chronic cough associated with loss of appetite and loss of weight. Investigations including CT Scan and Endoscopic ultrasound revealed multiple mediastinal lymphadenopathy and peripancreatic lymphadenopathy with central caseation necrosis. Histology of cervical lymph node was suggestive of tuberculosis and mycobacterium PCR was positive. The patient was subsequently treated with antituberculous therapy and had marked clinical improvement of his symptoms. This case outlines a rare presentation of a common disease and the application of newer investigative tools in making the diagnosis.

Matched MeSH terms: Tuberculosis, Lymph Node

Diagnostic challenges in tuberculous otitis media

Tang IP, Prepageran N, Ong CA, Puraviappan P

J Laryngol Otol, 2010 Aug;124(8):913-5.

PMID: 20426886 DOI: 10.1017/S0022215110000265

To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases.

Matched MeSH terms: Tuberculosis, Lymph Node/diagnosis; Tuberculosis, Lymph Node/drug therapy

Unusual case of cerebral demyelination and bilateral optic neuritis in an infant with suppurative BCG lymphadenitis

Anandakrishnan P, Khoo TB

BMJ Case Rep, 2018 May 30;2018.

PMID: 29848532 DOI: 10.1136/bcr-2018-224496

Cerebral demyelination and optic neuritis are often seen in children with acute disseminated encephalomyelitis following various infections and immunisations. An eight month old girl presented with a left axillary lymph node swelling and an erythematous lace-like rash over her cheeks and trunk. She then developed acute encephalopathy, bilateral nystagmus, right hemiparesis and left facial nerve palsy. Her electroencephalogram showed an encephalopathic process and visual evoked response study were grossly abnormal. Her MRI brain showed hyperintensities in the midbrain, pons and bilateral cerebellar peduncles. She was treated as postinfectious cerebral demyelination with intravenous antibiotics, methylprednisolone and immunoglobulin. Left axillary lymph node excision biopsy and GeneXpert test detected Mycobacterium tuberculosis complex that prompted initiation of antituberculous therapy. Her chest X-ray and cerebrospinal fluid examinations for tuberculosis were normal. She showed significant recovery after 2 weeks. This case illustrates a rare presentation of cerebral demyelination and bilateral optic neuritis following suppurative BCG lymphadenitis.

Matched MeSH terms: Tuberculosis, Lymph Node/chemically induced*

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