Adenomegalias cervicales persistentes: reporte de caso y desafío diagnóstico entre infección y neoplasia

Resumen

Se presenta el caso de una mujer de 53 años, previamente sana, que consultó por adenomegalias cervicales anteriores persistentes de dos meses de evolución, tratadas inicialmente con amoxicilina/ácido clavulánico con mejoría parcial. La evolución clínica se complicó con edema articular, cambios cutáneos en miembros inferiores y fiebre vespertina de hasta 39 °C. La biopsia por aspiración con aguja fina (BAAF) sugirió linfadenitis aguda supurativa, hallazgo que no explicaba completamente la persistencia de las adenopatías. A pesar de múltiples valoraciones en distintos servicios y centros, no se alcanzó un diagnóstico definitivo hasta la realización de una biopsia escisional, que confirmó linfadenitis granulomatosa necrotizante compatible con tuberculosis ganglionar. Este caso ilustra la necesidad de mantener un alto índice de sospecha de tuberculosis extrapulmonar en pacientes con adenomegalias cervicales persistentes, así como la importancia de un abordaje multidisciplinario y del uso oportuno de la biopsia escisional cuando la BAAF resulta no concluyente.

Abstract

We present the case of a 53-year-old previously healthy woman who attended consultation for persistent anterior cervical lymphadenopathy of two months’ duration, initially treated with amoxicillin/clavulanic acid with partial improvement. Her clinical course was subsequently complicated by joint edema, skin changes in the lower limbs, and evening fever reaching 39 °C. Fine-needle aspiration biopsy suggested acute suppurative lymphadenitis, a finding that did not fully account for the persistence of lymph node enlargement. Despite multiple evaluations by different specialties and at several centers, a definitive diagnosis was only achieved after excisional biopsy, which confirmed necrotizing granulomatous lymphadenitis consistent with tuberculous lymphadenitis. This case highlights the need to maintain a high index of suspicion for extrapulmonary tuberculosis in patients with persistent cervical lymphadenopathy, as well as the importance of a multidisciplinary approach and timely use of excisional biopsy when fine-needle aspiration is non-diagnostic.

Abstract

We present the case of a 53-year-old previously healthy woman who attended consultation for persistent anterior cervical lymphadenopathy of two months’ duration, initially treated with amoxicillin/clavulanic acid with partial improvement. Her clinical course was subsequently complicated by joint edema, skin changes in the lower limbs, and evening fever reaching 39 °C. Fine-needle aspiration biopsy suggested acute suppurative lymphadenitis, a finding that did not fully account for the persistence of lymph node enlargement. Despite multiple evaluations by different specialties and at several centers, a definitive diagnosis was only achieved after excisional biopsy, which confirmed necrotizing granulomatous lymphadenitis consistent with tuberculous lymphadenitis. This case highlights the need to maintain a high index of suspicion for extrapulmonary tuberculosis in patients with persistent cervical lymphadenopathy, as well as the importance of a multidisciplinary approach and timely use of excisional biopsy when fine-needle aspiration is non-diagnostic.