Chronic neck lymphadenitis – challenges in the diagnosis of extrapulmonary tuberculosis

Neck lymph node involvement is common in infections caused by various microorganisms, but determining the causative agent can be challenging. The case study details a 58-year-old male with left-sided cervical lymphadenopathy, fever, and weight loss persisting for two years. Despite extensive testing and empirical treatments, the cause remained unidentified. A CT scan revealed numerous enlarged lymph nodes with central necrosis. Histopathological examination suggested granulomatous lymphadenitis, although no bacteria were initially detected. Eventually, acid-fast bacilli were found via Ziehl-Neelsen staining, and Mycobacterium tuberculosis was confirmed through molecular tests. The patient was diagnosed with tuberculosis (TB) and successfully treated with anti-tuberculous therapy. The case highlights the diagnostic challenges of extrapulmonary TB, and underscores the importance of considering TB in atypical presentations, especially given the rise in multidrug-resistant strains.