Tuberculosis presenting with necrotic retroperitoneal lymphadenopathy in an immunocompetent patient: A case report and literature review

Background: Extrapulmonary tuberculosis (EPTB) accounts for 15-20 % of TB, but necrotic retroperitoneal lymphadenopathy is exceptionally rare, particularly in immunocompetent hosts. Case presentation: . Chest CT demonstrated additional necrotic mediastinal nodes without parenchymal disease. Standard therapy (2HRZE/4HR) was initiated; due to partial radiologic response at six months, isoniazid-rifampicin was extended to complete ten months, achieving full clinical and imaging resolution. Literature review: A structured search identified seven additional immunocompetent adults with necrotic retroperitoneal lymphadenopathy. Abdominal pain predominated; CT consistently showed multiple necrotic nodes. Final diagnoses were tuberculosis (3/7), high-grade B-cell lymphoma (2/7), Kikuchi-Fujimoto disease (1/7), and metastatic esophageal carcinoma (1/7). All cases required tissue confirmation. Conclusions: Necrotic retroperitoneal lymphadenopathy is an uncommon manifestation of TB that can mimic malignancy. In patients from TB-endemic settings, TB should remain high in the differential when CT demonstrates necrotic retroperitoneal nodes. Early image-guided biopsy with mycobacterial testing is decisive. Drug-susceptible disease generally responds to standard six-month therapy, although extended treatment may be warranted for delayed radiologic response.