A 40 year old HIV positive lady presented with multiple discrete firm lymphadenopathy in the posterior cervical and supraclavicular region of 6 months duration. She also complaining of chronic cough during this period. Surgical biopsy was taken from the lymph nodes and diagnosed as TB lymphadenitis. TRUE statement in this setting is:
HIV patient, if presents with Lymphadenoapthy TB is the first thing to be ruled out. FACTS The most common extrapulmonary TB in HIV positive and negative patients is TB lymphadenitis. Associted pulmonary disease is seen in < 50 patients. Systemic symptoms are more common in HIV positive patients. In biopsy specimens granulomas are less seen in HIV patients but with heavy load of bacteria so higher yields from microscopy and culture. D/D in this setting: 1. Kikuchi's disease 2. Kimura's disease 3. Castleman's disease 4. Lymphoma Here our patient has Tb lymphadenopathy and pulmonary symptoms in the form of chronic cough. The biopsy specimen will be studded with organism as she is HIV positive. Ref: Harrison, Edition - 18, Page - 1346
Granuloma in lymphnode biopsy specimen will be more in this patient
Higher bacteriological yield from microscopy and culture
Impoant differential diagnosis is Kikuchi's disease
Systemic symptoms are uncommon in HIV infected persons due to associated pulmonary diseasse