Mediastinal tuberculous lymphadenitis presenting with insidious back pain in a male adult: a case report and review of the literature

Abstract

Mediastinal tuberculous lymphadenitis (MTL) is mostly observed in primary tuberculosis in infants, children and adolescents, and is not found commonly in adults. Mediastinal tuberculous lymphadenitis cases may present with an insidious progression of tuberculous symptoms, including gradual deterioration in the lungs and a variety of clinical characteristics; however, initial symptoms are rarely only chronic back pain. We present the case of a 33-year-old man with mediastinal tuberculous lymphadenitis misdiagnosed as myofascitis. Since such individuals do not develop respiratory symptoms in the initial stages, they often go undiagnosed and can potentially spread tuberculosis.

Keywords: Lymphadenitis; extrapulmonary tuberculosis; hilum; imaging; mediastinum; pain; tuberculosis.

Figure 1.

(a) Interscapular and spinous process region tenderness. (b) Chest radiograph clearly showing enlarged right hilar and paratracheal lymph nodes (red arrow).

Figure 2.

Thoracic computed tomography, which was performed at a local hospital, showing enlarged lymph nodes in the right hilar, paratracheal and prevascular regions (arrows) with no obvious compression or erosion of the trachea. There were no prominent changes in the imaging signs of the pulmonary interstitial tissue at this point in the patient’s progression.

Figure 3.

Enlarged lymph nodes causing extrinsic bronchial compression and erosion through the bronchial wall into the bronchial airway (arrow 1). There are obvious changes in the images of the pulmonary interstitial tissue (arrow 2).

Figure 4.

Thoracic computed tomography showing newly increased inflammation owing to mediastinal lymphadenitis after 2 months of antituberculosis treatment (arrows). The patient’s back pain worsened significantly, accompanied by painful dysphagia.

Figure 5.

Obvious shrinkage is visible in the images regarding the lung and bronchial compression, along with a significant improvement in hilar lymphadenitis after 12 months of antituberculosis treatment (arrows). The patient experienced considerable relief from his back pain.