Axillary Tuberculous Lymphadenitis: a Case Report and a Literature Review

Abstract

INTRODUCTION: Tuberculosis (TB) still accounts for a high burden disease. It has been estimated that one third of the world population is infected with M. tuberculosis, the most residing in developing countries. In Brazil, according to literature, about twenty five percent of population is infected by Koch s bacillus and approximately 100, 000 new cases per year are registered. Extra-pulmonary TB accounts for 7-30 percent of all TB cases, and Seventeen to forty-three percent of that cases are lymphadenitis. The lymph node tuberculosis is the second most common manifestation of extra-pulmonary TB. The Cervical lymph nodes are most commonly affected, and axillary lymph nodes are involved in only 3. 8-20. 3 percent of TB lymphadenitis. Axillary tuberculous lymphadenitis is rare and has major prevalence between 20 and 50 years old. It can be confused with Breast carcinoma or can exist both at the same time. REPORTING: M. D. S. R. , 66 years old, female, reported the appearance of a hardened nodule in the right axillary for six months. In the physical check-up, it was found a hardened nodule and a skin thickening in the right axillary extension. A mammography and ultrasonography were made on both Breast and the findings of they showed two high density lymph nodes and 2 images with heterogeneous texture in the right axillary extension. Also, a Tomography of the chest was made and it showed a residual lesion in the right lung. The patient was submitted to an excisional biopsy of the right axillary lymph nodes. The Histopathologic evaluation demonstrated the presence of lymph node tuberculosis, presence of chronicle granulomatous lymphadenitis and presence of central caseous necrosis, favoring tuberculous etiology. The treatment for the axillary tuberculous lymphadenitis was conducted with rifampin, isoniazid and pyrazinamide for one year. DISCUSSION: Our patient was from Paraiba, Northeast of Brazil. In 2011, 1. 087 new cases of TB were diagnosed in the state. Risk factors of TB lymphadenitis include young age, female, and HIV infection, but it can occur in patients of old ages without HIV infection, as we have seen in this patient. Mammographic and ultrasonography features of the axillary lymph node in our patient were not as helpful in diagnosis as the biopsy of the lymph node. Axillary tuberculous lymphadenitis diagnosis depends on the complete pathological examination. TB was supposed to be considered in the differential diagnosis of patients who present with axillary lymphadenopathy, especially in the endemic areas of TB. KEYWORDS: Tuberculosis, Lymphadenitis, Axillary.