Abstract

REBELO, Tânia; FIUZA, Joana  and  MENDES, Álvaro. When the “evil” is not evil!. Rev Port Med Geral Fam [online]. 2020, vol.36, n.3, pp.321-326. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i3.12565.

Introduction: Among the numerous causes of lymphadenopathy, tuberculosis and lymphoma are relatively common and potentially curable. Lymph node tuberculosis is the most common site of extrapulmonary tuberculosis, with cervical ganglia being most affected. Case description: An 87-year-old Caucasian male from an extended family with a low average social class, severely dependent on the Barthel scale. Had a previous history of cerebrovascular disease, paroxysmal atrial fibrillation, and heart failure with mid-range ejection fraction. The patient was observed at home by his family doctor for a ‘neck lump’ that had arisen about four days earlier. He had left supraclavicular lymphadenopathy with local pain and anorexia. He had no fever, cough, night sweats, or weight loss. Lymphadenopathy presented suspicious characteristics and local inflammatory signs. Antibiotherapy was instituted and an ultrasound of soft tissues was requested. Ultrasound suggested a possible lymphoproliferative disease or bacillary adenitis. Due to the absence of response to antibiotic therapy, an analytical study with no relevant alterations and CT scan of the thorax revealing an adenopathic conglomerate with some associated necrosis in the left supraclavicular cavity, the patient was referred to the Emergency Department and hospitalized for study. The BAAR/DNA BK test in the exudate was positive, so it was assumed that it was compatible with tuberculous lymphadenitis and the patient started tuberculostatics. He was discharged with a referral to the Center for Pneumological Diagnosis. Commentary: Establishing a diagnosis of extrapulmonary tuberculosis is a challenge. The continuity of care by the family doctor allows the follow-up of the clinical evolution in order to adopt the approach that the doctor considers timelier. In addition, it makes it possible to anticipate and prepare the family for a possible crisis and provide the support for better psychosocial stabilization of the household family.

Keywords : Tuberculous lymphadenopathy; Extrapulmonary tuberculosis; Lymphadenopathy.

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