Abdominal lymphadenopathy: An interesting and rare case diagnosed on endoscopic ultrasound-guided fine needle aspiration cytology.

Abstract

A 68-year-old woman presented to a gastroenterologist with abdominal pain, loss of appetite, and significant weight loss for last 5–6 months. Her history revealed that she had been having recurrent episodes of abdominal pain for last 15 years with postprandial distension and vomiting. She had taken two courses of anti-tubercular therapy (ATT) in the past. These were probably given empirically as no tissue diagnosis was available. She had been investigated extensively in another hospital for her present complaints; however, no diagnosis could be made. Computed tomography scan done outside revealed multiple calcified and noncalcified lymph nodes in the axilla, chest, and abdomen, and healed calcified foci in liver and spleen. There were fibro-calcified lesions in bilateral upper lobes of the lung. There was also mild ascites and bilateral pleural effusions. Physical examination revealed pallor, pedal edema, basal crepitation, and hepatomegaly. She had albuminuria, and 24 h urinary protein levels were raised. Her echocardiography revealed mild pulmonary arterial hypertension. She underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the abdominal lymph nodes with a clinical suspicion of tuberculosis. The EUS-FNA was performed using 22 G needle from the peri-pancreatic lymph nodes [Figures ​[Figures11 and ​and22].