SESSION TITLE: Student/Resident Case Report Poster - Chest Infections I SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Annually, there are more than 8 million new cases of tuberculosis (TB) worldwide, leading to nearly 1.5 million deaths. In non-endemic TB countries, the proportion of extra-pulmonary TB cases are increasing, mainly due to TB lymphadenitis. In the United States, nearly 10% of cases of TB are due to TB lymphadenitis. CASE PRESENTATION: A 39-year-old female originally from Eritrea presented to her primary care provider with intermittent lymphadenopathy over the past 3 years, manifesting as marble-sized lesions on her neck and axilla, which have fluctuated in size over the past few years. She also complained of skin lesions and drainage of pus from her left breast. The patient reported past exposure to TB and a history of a positive PPD that was never treated. Chest X Ray was unremarkable. A CT scan of the neck and chest revealed abscesses and adenopathy involving the left chest wall, axilla and left breast with sinus tract drainage. A Fine Needle Aspiration (FNA) was performed on an enlarged lymph node with histopathology revealing necrotizing granulomas with micro-abscess formation. MTB Polymerase Chain Reaction (PCR) which was positive for TB, and culture was also positive for TB. HIV was negative. She was diagnosed with extra-pulmonary TB lymphadenitis involving the breast with a draining sinus tract. Standard RIPE therapy was recommended. However, she was intolerant of Pyrazinamide and was placed on triple-therapy for nine months. DISCUSSION: Tuberculous lymphadenitis typically presents as slowly enlarging, often painless, lymph nodes with the mean duration of symptom onset to presentation typically being 1-2 months. Systemic symptoms such as fever and weight loss are less common in TB lymphadenitis, especially in patients not co-infected with HIV. A draining sinus tract is present in up to 11% of cases. The diagnosis of TB lymphadenitis is made either by culture or a positive MTB PCR from the lymph node in question. The Infectious Disease Society of America (IDSA) recommend 6 months of treatment with RIPE for TB lymphadenitis. CONCLUSIONS: A high degree of clinical suspicion is necessary for diagnosis of TB lymphadenitis, especially in patients from TB endemic area. Nearly 10% of all cases of TB are TB lymphadenitis. Ruling out co-infection with HIV is essential. Treatment is similar to pulmonary TB, as the IDSA recommends RIPE therapy for 6 months. Reference #1: Blumberg, H. M., W. J. Burman, et al. (2003). “American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis.” American journal of respiratory and critical care medicine 167(4): 603-662. Reference #2: Fontanilla, J. M., et al. (2011). “Current diagnosis and management of peripheral tuberculous lymphadenitis.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 53(6): 555-562. Reference #3: Zumla, A., M. Raviglione, et al. (2013). “Tuberculosis.” The New England journal of medicine 368(8): 745-755. DISCLOSURE: The following authors have nothing to disclose: Daniel Reynolds, Megan Dulohery No Product/Research Disclosure Information