Published: 2021-09-22

Varied presentation of tuberculosis adenopathy: an immunological and diagnostic contemplation

Natesh Ganesan, Sachin Vidyasagar, Anbumaran Parivakkam Mani, Gangadharan Vadivelu


Tuberculous lymphadenitis is the most common presentation of extra pulmonary tuberculosis EPTB. Clinical and radiological presentation of disease may vary and differential diagnosis includes both benign and malignant conditions such as lymphomas and sarcoidosis. We present two case reports of tuberculous lymphadenitis with varied presentation. In case report Ⅰ, patient had undergone splenectomy due to traumatic splenic rupture had classical symptoms of tuberculosis, chest X-ray, CT thorax showed mediastinal and cervical lymphadenopathy. FNAC showed a picture of granulomatous lesion. In case report ⅠⅠ patient came with complaints of abdominal pain in hypochondriac region. CT and USG abdomen showed multiple enlarged retroperitoneal lymph nodes which led to a provisional diagnosis of lymphoma after which lymph node biopsy showed a granulomatous picture. This case report stresses the importance of early and quick diagnosis of tuberculosis in immunocompromised patients and highlights the risk of misdiagnosis of tuberculous lymphadenitis with other benign and malignant causes of lymphadenopathy and the importance of humoral mediated immunity in tuberculosis.


Humoral immunity in tuberculosis, Granulomatous lesions, Diagnostic challenges

Full Text:



Singh S, Pandey D, Ahmad Z. unusual presentation of tuberculosis. Tropical Doctor. 2009;39(3):183-4.

Gupta PR. Difficulties in managing lymph node tuberculosis. Lung India. 2004;21:50-3.

Asano S. Granulomatous lymphadenitis. J Clin Exp Hematop. 2012;52(1):1-16.

Lai SW, Wang IK, Lin CL, Chen HJ, Liao KF. Splenectomy correlates with increased risk of pulmonary tuberculosis: a case-control study in Taiwan. Clin Microbiol Infect. 2014;20(8):764-7.

Kozakiewicz L, Phuah J, Flynn J, Chan J. The role of B cells and humoral immunity in Mycobacterium tuberculosis infection. Adv Exp Med Biol. 2013;783:225-50.

Chan J, Mehta S, Bharrhan S, Chen Y, Achkar JM, Casadevall A, Flynn J. The role of B cells and humoral immunity in Mycobacterium tuberculosis infection. Semin Immunol. 2014;26(6):588-600.

Purohit M, Mustafa T. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need. J Clin Diagn Res. 2015;9(4):EE01-6.

Sinan T, Sheikh M, Ramadan S, Sahwney S, Behbehani A. CT features in abdominal tuberculosis: 20 years experience. BMC Med Imaging. 2002;2(1):3.

Thakkar K, Ghaisas SM, Singh M. Lymphadenopathy: Differentiation between Tuberculosis and Other Non-Tuberculosis Causes like Follicular Lymphoma. Front Public Health. 2016;4:31.