45F with intermittent fever and wt loss. T4 mildly elevated. FNAC showing chronic non specific reactive lymphadenitis. kindly suggest DD & Rx
H/o intermittent fever with weight loss and non specific lymphadenitis goes more in favour of Tubercular Lymphadenitis. Get ESR which may be helpful in diagnosis as it usually falls when pt. improves with anti- tubercular drugs. Mx may also be helpful in coming to a diagnosis. Sputum for AFB if pt has kock’s chest. Elisa TB gold test may also be helpful. 2nd DD would be Hodgkin’s / Non Hodgkin’s lymphoma which is usually missed on FNAC and needs Bx for a diagnosis. Metastatatic carcinoma should also be kept in differential as FNAC may not be positive always till the whole node is involved. Granulomatous disease should also be kept in mind. Bx should click the final diagnosis.
Nodular swellings are multiple and at angle of mandible lt side Fnac suggest reactive lymphadenopathy Most likely tb adenitis Confirm by excisional biopsy So far raised t4 is concerned need to review
Swelling in level 3 and 2. If it is a reactive lymphadenitis check for pathology in base of tongue, oropharynx, tonsils, larynx, etc. Rule out TB, go for USG neck, and also a triple endoscopy. If features of malignant nodes in USG need to go for a PET scan to rule out unknown primary
Multiple nodular neck may be due lymphadenitis D/D A. Inflammatory a. Oral , dental and ear sepsis b. Tuberculosis B. Malignancy a. Primary Lymphoma Hodgkin and non Hodgkin b. Secondary metastais Blood examination X-ray chest Mantaux test FNAC or exision biopsy of lymph node May be lipoma /
Look for physical palpation findings of nodes whether discrete or matted?/consistency....? DDs tubercular lymphadenitis Hodgkin's... Adv excision biopsy n manage according ly.
T B aenitis d/d Hodgkins Confirm by excesion biopsy For T4 to be reviewed with other symptoms
Mostly tubercular cervical,if it is firm.rubbery Hodgkin .ulcer on lip syphilis,if it is hard secondries, ulcer on tongue most squamous carcinoma I nfectious mononucleosis if h/o Amoxicillin intake made prominent swelling, carcims thyroid and hasimotosis with toxic symptoms,primary caner in head and neck area,viral adenitis with non specific fever dental caries ,irritants like panparag,chuna etc,finally AIDS
H/o intermittent fever with weight loss and non specific lymphadenitis goes more in favour of Tubercular Lymphadenitis. Get ESR which may be helpful in diagnosis as it usually falls when pt. improves with anti- tubercular drugs. Mx may also be helpful in coming to a diagnosis. Sputum for AFB if pt has kock’s chest. Elisa TB gold test may also be helpful. 2nd DD would be Hodgkin’s / Non Hodgkin’s lymphoma which is usually missed on FNAC and needs Bx for a diagnosis. Metastatatic carcinoma should also be kept in differential as FNAC may not be positive always till the whole node is involved. Granulomatous disease should also be kept in mind. Bx should click the final diagnosis.
Need to check drainage area( naso ,oropharynx, larynx) for infection .with ENT check . Biopsy of lymph node is mandatory .
Every one has seen this case in ones own eyes, great, all of you deserve a great applause.
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