A 9 year old girl presented with multiple swellings left side of neck since 2 months. Non tender and matted. FNAC of the swellings suggested as non specific lymphadenitis. ESR 40 mm/1st hour. Montoux Test negative. CXR normal. No history of cough/fever. h/o chicken pox 6 months back. Diagnosis and management.

7 Likes

LikeAnswersShare

Sometimes FNAC may be inconclusive. So, in this case excision biopsy is helpful to arrive at final diagnosis. Rule out HIV 1&2 Ab. Half of the tissue sent to Pathology for HP examination by different stained smears to rule out / in Lymphomas / Lymphoproliferative disorders / Subcutaneous mycosis (Sporotrichosis or any other.....) . Rest half of the tissue for Microbiology Dept, for impression smears for Gram's stain, smashed tissue for Z.N Stain, a portion for KOH Preparation and rest of the tissue for routine culture, AFB culture and GeneXpert / CBNAAT,to get early rtp

to get early report on resistant pattern, if it is Tubercular lymphadenitis especially by Atypical mycobacteria.
0

View 1 other reply

It should be glandular TB. Please do biopsy of whole gland. One half for CBNAAT other for histo. Hiv to exclude .lymphoma with be excluded in histo. By that time try with antidandruff shampoo and cefpodoxim

I agree with Dr Tapas Har, send for HPE, CBNAAT? C&DST
0

Lymphafenopathy x 2 months. Non-Tender, & Matted. FNAC : NON SPECIFIC LYMPHADENITIS. Mx : NEGATIVE, ESR 40 mm 1st hour. CXR : NORMAL. POST VARICELLA 6 MONTHS. NEEDS CATEFUL EVALUATION. EXCISION BIOPSY WITH "IMMUNO-HISTOCHEMISTRY" IS MANDATORY.

FNAC many times inconclusive go for open biopsy and gross nd histopathologic examination. Matted glands mostly TB

If it's matted lymph node then high likely to be TB I agree with @Dr. Vamshi Krishna that it need EXCISION BIOPSY as FNAC often misses.

Better do cxr and USG abdomen to evaluate for other regional lymph nodes enlargement. If present and excisional biopsy is suggestive of lymphoma do CT scan for staging..

Excisional biopsy Case is TB lymphadenitis

Matted LN Excisional bx for histopathology & gene xpert

First r/o head lice(pediculosis) Dental caries

Needs biopsy TB most likely

Load more answers