Michaelides Stylianos A, Bablekos George D, Michailidis Avgerinos-Romanos, Gkioxari Efthalia, Vgenopoulou Stephanie, Chorti Maria
Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio- Amalia Fleming" General Hospital, 1 Sismanogleiou Str, 15126, Attiki, Maroussi, Athens, Greece.
Departments of Biomedical Sciences, Nursing and Physiotherapy, University of West Attica, Campus 1, Attiki, Egaleo, Agiou Spiridonos, 12243 Athens, Greece.
Case Rep Med. 2019 Jul 25;2019:7838596. doi: 10.1155/2019/7838596. eCollection 2019.
The aim of the present study is to describe an uncommon case of tuberculous lymphadenitis (TL) in a symptomless 89-year-old male smoker patient, who presented at the emergency department of our hospital with left lateral cervical swelling with draining sinuses. No other clinical symptoms or physical findings were observed at admission. An elevated erythrocyte sedimentation rate (ESR) and a small calcified nodule in chest CT were the only abnormal findings. Pus samples from sinuses were examined and confirmed tuberculosis which was in agreement with surgical pathology of lymph nodes. A four- (4-) drug antituberculous regimen was administered. After an initial remission of his symptoms, the patient presented an exacerbation of the cervical swelling with draining sinuses necessitating addition of oral steroids. TL can be symptomless presenting a paradoxical reaction during treatment. The uniqueness of our case lies in the patient's advanced age, which is uncommon with cervical lymphadenopathy as a form of extrapulmonary tuberculosis, as well as in the administration of oral steroids to resolve the neck's clinical deterioration. The patient had a complete recovery and was free of disease after completion of his six-month antituberculous chemotherapy.
本研究的目的是描述一例罕见的结核性淋巴结炎（TL）病例，患者为一名89岁无症状男性吸烟者，因左侧颈部肿胀伴引流窦道就诊于我院急诊科。入院时未观察到其他临床症状或体征。红细胞沉降率（ESR）升高和胸部CT显示一个小钙化结节是仅有的异常发现。对窦道的脓液样本进行检查并确诊为结核病，这与淋巴结的手术病理结果一致。给予四联抗结核治疗方案。在症状初步缓解后，患者出现颈部肿胀伴引流窦道加重，需要加用口服类固醇。TL可能无症状，并在治疗期间出现矛盾反应。我们病例的独特之处在于患者年龄较大，这在以颈淋巴结病形式出现的肺外结核中并不常见，以及使用口服类固醇来缓解颈部的临床恶化。患者在完成六个月的抗结核化疗后完全康复且无疾病。
