Cervical lymphadenopathy, caused by various infections and tumors, is commonly encountered in clinical practice. Definitive diagnosis of this condition should always follow a differential diagnosis. Here we report a case of miliary tuberculosis in a 58-year-old woman who visited our department with a chief complaint of cervical lymphadenopathy. Three months earlier, she developed progressively worsening pain in the left shoulder, followed by swelling in the left shoulder extending to the supraclavicular region. Administration of non-steroidal anti-inflammatory drugs prescribed for shoulder periarthritis did not improve her symptoms, and she continued to have a fever above 39°C. Although ultrasonography and hematology findings were initially indicative of purulent lymphadenitis, administration of antibiotics failed to improve her symptoms. The patient visited our department for a complete evaluation, which revealed lymphadenopathy in the left supraclavicular fossa with no tumor-like lesions in the laryngopharynx, indicating tuberculous lymphadenitis. During the course of clinical observation, the patient developed skin redness which expanded over time and was positive for interferon gamma specific to Mycobacterium tuberculosis in an enzyme-linked immunosorbent spot assay. Although her symptoms and clinical findings led to a diagnosis of tuberculous lymphadenitis, metastatic tumor could not be excluded because neck computed tomography (CT) showed multiple shadows in the lungs. The patient was admitted for further evaluation because of the negative results of acid-fast bacilli smears of sputum and gastric aspirates, lack of bacterial shedding, and persistent fever. Due to the absence of tumor-like lesions that could cause similar symptoms, fine-needle aspiration and polymerase chain reaction for the detection of M. tuberculosis were performed to make a definitive diagnosis of tuberculous cervical lymphadenitis. In addition, follow-up CT revealed a newly developed pulmonary nodule, despite shrinkage of the initial pulmonary nodule, leading to the diagnosis of miliary tuberculosis. The patient was transferred to the Department of Internal Medicine for the administration of anti-tuberculosis drugs, which improved her fever and general symptoms. Because miliary tuberculosis presents a wide variety of chest CT imaging features, it is sometimes difficult to differentiate the disease from other pulmonary and metastatic lesions. In addition, cervical lymphadenitis usually has no general symptoms and often develops as chronic lymphadenopathy without tenderness. However, as in the present case, it is possible for patients with the chief complaint of fever and lymph node tenderness to have tuberculous lymphadenitis, necessitating the exclusion of tuberculosis in the presence of a cervical mass.
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