Title : Multisystem extrapulmonary tuberculosis presenting as persistent cervical lymphadenopathy in an immunocompetent child: A diagnostic challenge
Abstract:
Persistent cervical lymphadenopathy in children is most commonly associated with self-limited infectious diseases. However, prolonged lymph node enlargement, particularly when accompanied by atypical clinical features, should prompt investigation for less common etiologies, including extrapulmonary tuberculosis.
We report the case of an 8-year-old previously healthy boy who presented with painless right cervical lymphadenopathy persisting for five months, without constitutional or respiratory symptoms. Initial laboratory investigations, including serologic testing for common infectious etiologies, were unremarkable. Neck ultrasonography revealed a hypoechoic lymph node with internal hyperechoic foci. Although chest radiography showed no pulmonary abnormalities, it unexpectedly identified a lytic lesion in the proximal left humerus. Magnetic resonance imaging further characterized this finding as chronic osteomyelitis. A tuberculin skin test demonstrated an induration of 12 mm. Excisional biopsy of the cervical lymph node revealed necrotizing granulomatous lymphadenitis with caseous necrosis, confirming tuberculous lymphadenitis.
The coexistence of cervical lymphadenitis and osteomyelitis established the diagnosis of multisystem extrapulmonary tuberculosis in the absence of pulmonary involvement. Antituberculous therapy was initiated, resulting in a favorable clinical and radiological response.
This case highlights the importance of considering extrapulmonary tuberculosis in children presenting with persistent cervical lymphadenopathy, even in the absence of respiratory or constitutional manifestations. It also underscores the diagnostic value of a comprehensive approach integrating clinical and epidemiological history, targeted imaging, and histopathological evaluation. Early recognition of atypical extrapulmonary presentations is essential to ensure timely treatment and prevent disease progression and complications.
