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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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MEDIASTINAL LYMPHADENOPATHY: CHALLENGES IN DIFFERENTIAL DIAGNOSIS

Catarina Cristina1, Marisa Inácio Oliveira1, Maria João Brito1, Catarina Gouveia1

1 Unidade de Infeciologia do Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE

- 10th WorldCongressoftheWorldSociety for PediatricInfectiousDiseases, publicação sob a forma de E-Poster

Resumo:
Introduction: Portugal has an incidence of tuberculosis of 18/100000 habitants, however, in urban areas and immigrant communities it is higher. Diagnosis requires a high level of suspicion.
Case report: 15-year-old previously healthy male born in Guinea, living in Lisbon for two years, was admitted with sternal, cervical and lombar pain for one month. He also referred low grade fever, asthenia, anorexia and unquantified weight loss. He was emaciated, with sternal edema and pain on palpation. Also, cervical and lumbar spine were painful on mobilization. Lab tests revealed a normal CBC, CRP 24.5mg/dl, ESR 60mm/h. IGRA-Quantiferon was negative but IGRA T-SPOT was positive and HIV negative. BK staining, culture and nucleic acid amplification tests were negative on sputum. Chest, abdominal and pelvic CT showed a pre-aortic adenopathy conglomerate (90x41x49mm) with central necrosis and multiple spleen nodules. Spinal MRI demonstrated T2 diffuse hypersignal and edema of C3, D11 and L3 vertebral body. Biopsy of mediastinal lymphadenopathy revealed a necrotizing granulomatous inflammatory process. BK staining and molecular amplification on the biopsy were negative. Empirical anti-tuberculosis therapy was started. Later, cultural exam of biopsy identified Mycobacterium tuberculosis, confirming presumed diagnosis.
Discussion:Differencial diagnosis of mediastinal lymphadenopathy is challenging. Definite diagnosis of tuberculosis requires a positive BK staining, molecular amplification or cultural tests. However, owing to the paucibacillary nature of the specimens, the sensitivity of these tests are low. Despite useful, sensitivity of IGRA tests is not established in extrapulmonary tuberculosis. In the presence of high clinical suspicion, the absence of diagnostic confirmation should not delay initiation of therapy.

Palavras Chave: IGRA;Mediastinal Lymphadenopathy; Tuberculosis