CRA47 A CASE OF METASTATIC CARCINOMA LYMPHADENOPATHY MASQUERADE AS A TUBERCULOUS LYMPHADENITIS

Nor Safiqah Sharil1, Aisyah Rahman2, Nik Nuratiqah Nik Abeed2, Ng Boon Hau2, Marfu’ah Nik Ezzamuddin2, Andrea Ban Yu-Lin2
1 Internal Medicine Unit, Faculty of Medicine and Health Science, University Sains Islam Malaysia, Negeri Sembilan, Malaysia
2 Faculty of Medicine, University Kebangsaan Malaysia

Introduction

Tuberculosis lymphadenitis typically manifests as a localized infection affecting lymph nodes in regions like the neck, chest, and abdomen. However, lymphadenopathy can also be indicative of malignancy, posing a diagnostic challenge. We present a case of tuberculosis lymphadenitis that showed a poor response to anti-tuberculous treatment, with subsequent biopsies revealing metastatic carcinoma.

Case Report

61-year-old man initially diagnosed with tuberculous lymphadenitis based on clinical and fine needle aspiration cytology (FNAC) of chronic granulomatous inflammation. Despite standard anti-tuberculous therapy, the left cervical lymphadenopathy persisted and grew to 10 x 11 centimetres(cm). Contrast-enhanced computed tomography showed multiple lymphadenopathies in cervical, axillary, and abdominal with no obvious masses, hence positron emission tomography scans done revealed widespread lymphadenopathy with suspicion of periampullary malignancy. Endoscopic retrograde cholangio-pancreatography confirmed obstruction, leading to common bile duct stenting. Tumour markers were negative, but a true-cut biopsy of left cervical lymph node reported metastatic carcinoma with chronic granulomatous inflammation, while microbiological tests, Xpert MTB/RIF Ultra and culture were negative. The patient underwent a multidisciplinary evaluation, initiating a FOLFOX regime alongside continued anti-tuberculous therapy. After the third cycle, lymph nodes regressed to 2 x 1 cm, demonstrating a positive response to chemotherapy and anti-tuberculous treatment.

Discussion

The challenge of diagnosing chronic granulomatous inflammation in lymphadenopathy, especially when it responds poorly to anti-tuberculous therapy, necessitates exploring alternative diagnoses.