Between Malignancy and Infection: The Diagnostic Challenge of Tuberculous Cervical Lymhadenomegaly – A Case Report

Introduction. Tuberculous (TB) lymphadenitis is the most frequent extrapulmonary manifestation of Mycobacterium tuberculosis infection, with predominant involvement of the cervical lymph nodes (LN). Bilateral LN enlargement in elderly patients, especially in the presence of a thyroid nodule, may closely mimic malignant disease. This case highlights the diagnostic challenge of distinguishing TB from metastatic thyroid carcinoma and contributes to literature by emphasizing the role of minimally invasive and molecular techniques in diagnosis. Case report. An 83-year-old female was admitted with progressive bilateral cervical swelling, pain, and systemic symptoms, including weight loss, fatigue, and night sweats. Physical examination revealed bilateral cervical lymphadenopathy and a palpable thyroid nodule. Laboratory studies showed microcytic anemia, leukopenia, and subclinical hypothyroidism. Computed tomography demonstrated bilateral cervical and mesenteric lymphadenopathy, right pleural effusion with pulmonary consolidation, and splenomegaly. Fine-needle aspiration (FNA) of a cervical LN revealed granulomatous inflammation, while polymerase chain reaction (PCR) confirmed Mycobacterium tuberculosis. Cytological evaluation of the thyroid nodule was benign. A final diagnosis of disseminated extrapulmonary TB (EPTB) with LNs, pleural, and probable thyroid involvement was established. The patient was referred to a specialized tuberculosis clinic for further management, but follow-up data were not available. Conclusion. This case illustrates the diagnostic complexity of EPTB, particularly when concurrent thyroid pathology is present. In such patients, TB may be clinically and radiologically indistinguishable from metastatic malignancy. FNA combined with molecular testing significantly enhances diagnostic accuracy, reducing the need for excisional biopsy.