Endocrine Abstracts

Tuberculosis (TB) is a disease that affects all organs and progresses with a wide variety of clinical manifestations. Cases of extrapulmonary tuberculosis (EPTB) are particularly difficult to diagnose because of its atypical course.

Case: A 32-year-old female patient was evaluated in our clinic with the complaint of localized swelling in both supraclavicular regions (ScR) for one and a half months. There were no fevers, cough, or weight loss symptoms present. Ultrasonography showed approximately 6x6 mm calcified nodule in the left thyroid lobe and lymphadenopathy (LAP) of 3.2x2.4 cm in the left supraclavicular region (ScR) and 2.1x2 cm in the right ScR. A clinical diagnosis of metastasis of thyroid carcinoma or lymphoma were considered. In her family history, it was learned that her mother had TB and received treatment for 6 months. Hemoglobin 9.5 g/dl (11.7-15.5), the white blood cell count was 5,100 uL (4,4-11,3), erythrocyte sedimentation rate (ESR) was raised 1st hour 43 mm (<20), c-reactive protein of 8.2 mg/dl (<5). The results were negative for hepatitis markers, human immunodeficiency virus, toxoplasmosis, brucellosis and syphilis. Quantiferon-tb gold test was negative. Fine needle aspiration (FNA) cytology to the left thyroid lobe and left supraclavicular lymph nodes (ScLN) revealed epithelioid cells and necrotic material forming granulomas and lymphocytes. Thyroid nodule aspiration report: Atypia of undetermined significance. The real-time polymerase chain reaction (RT-PCR) test and Ziehl-Neelsen staining of the biopsy sample taken from the lesions in ScR were negative. No TB compatible lesion was found on computed tomography scan of the lung. Considering the pathology result and family history, tuberculous lymphadenitis was considered and 4-antituberculosis treatment was started. In the presence of palpable lymphadenopathy in countries where TB is common, TB should be considered in the etiology. TB affecting primarily ScLN is uncommon. In absence of systemic signs and symptoms, as in our case, it can be difficult to diagnose TB.

Keywords: Tuberculous lymphadenitis, extrapulmoner tuberculosis, thyroid nodule