?Granulomatous Lymphadenitis

Just came across this FNAC report over whatsapp, just like to know what further workup would be needed in such patient or directly we can jump on to ATT ? Chief Complaints He is a 20 year old male having swelling over left side lateral aspect of neck Management Your valuable opinions are welcome on this

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A young male of 20 years old with neck solitary swelling and F.N.A.C- suggestive of granulomatous lymphadenitis- most likely it is tuberculosis lymphadenitis. At the most - you can take second opinion of F.N.A.C slides. I think you should start with ATT - category 1 treatment- no point in going for other investigations- but get an X - ray chest done

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To me all all granulomatous lymphadenitis are not due to tuberculosis because in studies it has been found only 44% due to tuberculous and more than 45% due to reactive lymphadenopathy Only more than 4% due to primary malignancy may be Hodgekin or non Hodgekin and rest seconary metastasis. In addition to the above reasons there may be fungal or toxoplasmosis. Other than routine examination like blood examination, xray chest, MT other method of staining may be applied like Ziel Nelson test for presence of AFB. Last of all excision biopsy is the confirmation FNAC has got the falacies like false positive predictability and false negative predictability.

Thanks Dr Ajit Singh.
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Granuloma.. means chronic inflammatory lesion involving cells of reticuloendothelual system.. BOYD. Granuloma may be seenin many clinical conditions of diverse etiopathology. Sug. Clinicoimaging correlation Zn smear.. and cbnaat from fna material. Ex bx

Granulomatous lymphadinitis or Tubercular lymphadinitis Routine check must like CBC, ESR, CRP, CHEST XRAY OR CT NECK START ATT

In my experience in tuberculous lymphadenitis bld parameters are not changed usually . Investigations may be done for supportive evidence only and to rule out other causes of granulomatous lymphadenitis.
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