ISOLATED MEDIASTINAL LYMPHADENOPATHY: A GREAT DECEPTION

Abstract

TYPE: Case Report TOPIC: Procedures INTRODUCTION: Mediastinal lymph node enlargement can occur from a wide range of pathologies, either by its own or in association with other lung pathology. The spectrum of conditions that can result in mediastinal lymphadenopathy are tuberculosis, sarcoidosis, metastasis. The diagnosis is achieved by performing an EBUS-TBNA, as many times history and clinical features can be overlapping. Hence it is always advisable to get a tissue diagnosis of the nodes.Here we are presenting one unique and rare case of Rosai- Dorfman disease, which was initially treated as tuberculosis in a peripheral center , and later got a tissue biopsy done proving Rosai- Dorfman disease CASE PRESENTATION: 45 year old male with history of high grade fever for 10 months and significant loss of weight. HRCT thorax showed mediastinal lymphadenopathy for which he underwent CT guided biopsy which was inconclusive and started on anti koch’s treatment.However his symptoms persisted andhe was referred to our center in view of lymphoma or tuberculosis, and we proceeded with EBUS- TBNA. DISCUSSION: Histopathologic examination of the slides revealed sinus histiocytosis and EMPERIPOLESIS and IHC positive for S100 which is specific for Rosai- Dorfman disease. CONCLUSIONS: The diagnosis of every lymphadenopathy should be re-instated by a tissue diagnosis. Our case is unique and rare as there are only 4 cases of mediastinal lymphadenopathy reported as Rosai- Dorfman disease and the patient presented with isolated mediastinal lymphadenopathy , when all other reported cases had cervical and axillary lymphnode also as presentation. DISCLOSURE: Nothing to declare. KEYWORD: Mediastinal Lymphadenopathy