Concluded Case

M 24 c/o General weaknesses & chr fever with painful cervical lymph nodes for 1&1/2 years. No family history, patient had contact with one, sukha tb ie pleurisy or effusion. Patient presented with B/L multiple matted cervical lymph nodes with discharging sinus, painful, adherent to skin, some non-suppurative LN are mobile, non-tender on supraclavicular, submandibular,, Rt axillary areas. O/E Pulse 106bpm, regular, at present afebrile, built below average, poor nutrition, BP 100/60, other general survey unremarkable. RS normal, CVS S1S2, Abd semisoft, no ascietes, diffuse palpable LN No neurodeficit. INV Slight anaemic otherwise CBC Normal, HBsAg, Anti HCV negative, LFT Normal, Sugar F 94,PP 128,BT 1'45" CT 5'15" TSH 0.8,Urea 22,Creat 0.9,ICTC N/R, Sputum AFB -versicolor, Sodium 133.8,Potassium 4.03,ECG Sinus tachycardia Wedge biopsy of Cervical LN showed Nacroinflammatory tissue. AFB N/F. USG Abd multiple abd LN, peripancreatic, mesenteric, pre & para aortic & iliac. Prostetic cyst with wall calcification, B/L mild raised renal echogenicity USG neck multiple enlarged LN in level ll, lll, lV -large one 17mm in Lt side of level ll, B/L lobes of thyroid normal. What would be the diagnosis? What would be the line of management?

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Concluded answer

Scrofuloderma

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History and investigations suggest only one direction and ie TB ADENITIS with discharging sinuses Yes excisional biopsy of some of lymphnode will be confirmatory Discharge from sinus may be send for pcr also go for genxpert and cbnaat So far Rx will be ATT only

Thanx dr Raju Kumar
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It looks tubercular cervical lymphadenitis. What is ESR, please do cbnaat of the pus.

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Scrofuloderma

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Go for Iga and Igm for TB.

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Tubercular lymphadenopathy

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Most likely TB abd Biopsy from abd LN will confirm the diagnosis

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Tuberculosis of lymph nodes

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Most likely Tubercular lesions

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Sputum AFB negative

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