Abstract
This report presents a case of tuberculous lymphadenitis that was difficult to diagnose using polymerase chain reaction analysis. An 80-year-old Japanese female was hospitalized due to swollen cervical lymph nodes. Her lymph node tests revealed paradoxical polymerase chain reaction results. Polymerase chain reaction analysis of two biopsy tissues using the Cobas TaqMan revealed a positive result for Mycobacterium avium and a negative result for Mycobacterium tuberculosis. However, polymerase chain reaction analysis of a cultured colony of acid-fast bacteria from biopsy tissue using the Cobas TaqMan and an alternative polymerase chain reaction analysis of biopsy tissue yielded discordant results. The patient was diagnosed as having tuberculous lymphadenitis. She was treated with antitubercular drugs and subsequently had a reduction in cervical lymph node swelling. Polymerase chain reaction analysis is not 100% accurate; hence, its use as a diagnostic tool for mycobacterial infection requires increased attention.
Highlights
Tuberculosis is an infection that has affected humankind throughout history
These findings suggested that the patient not had only Mycobacterium avium lymphadenitis and tuberculous lymphadenitis, and isoniazid 300 mg daily was added to her regimen
The patient continued treatment for tuberculous lymphadenitis with antitubercular drugs and experienced a reduction in cervical lymph node swelling. This case highlights the diagnostic challenges of tuberculous lymphadenitis due to paradoxical results obtained by polymerase chain reaction (PCR) analysis
Summary
Tuberculosis is an infection that has affected humankind throughout history. The diagnostic capability for this disease has improved immeasurably during recent years. The definitive diagnosis of mycobacterial infection depends on microscopy, culture, and polymerase chain reaction (PCR) analysis [1,2,3]. PCR analysis has played an important role in Japan because it provides a speedy and exact diagnosis. Cobas TaqMan MTB/MAI is widely used for the detection of the Mycobacterium tuberculosis and Mycobacterium avium complex, and the technique has high sensitivity and specificity [1, 2]. The Cobas TaqMan MTB/MAI test is a real-time PCR assay for Mycobacterium tuberculosis complex, Mycobacterium avium, and Mycobacterium intracellulare [1]. This case report describes a case of tuberculous lymphadenitis that was difficult to diagnose by PCR analysis
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