Isolated inguinal tubercular lymphadenopathy

We report a very uncommon case of isolated inguinal tubercular lymphadenopathy in a 35-year-old lady with no other pulmonary or extra pulmonary tubercular infection. She responded very well to antitubercular treatment following histological confirmation.

Keywords: Chronic tropical infection, inguinal lymph node, tuberculosis

Isolated involvement of inguinal lymph nodes due to tubercular infection is relatively rare in adults. In the absence of pulmonary and/or extra pulmonary tuberculosis, inguinal tubercular lymphadenopathy is very difficult to differentiate from other causes of inguinal lymph node enlargement. This rarity is why our case is interesting.

We encountered a 35-year-old lady with isolated left inguinal lymph node enlargement for 3 months duration [Figure 1].There was no history of any pulmonary or extra pulmonary complaints which could give us any clue of the cause of her left inguinal swelling. On examination also, no lesion/site of infection could be detected in lower extremity and external genital region. FNAC revealed granulomatous reaction suggestive of tuberculosis. The mantoux test was also positive. She had no sign related to pulmonary or other extra pulmonary tubercular infection. X-rays of the chest and pelvic radiographs were also normal. The lymph node biopsy confirmed the diagnosis of tubercular infection. She was put on antitubercular treatment and responded very well with complete resolution of lesion within 2 months.

Isolated inguinal tubercular lymphadenopathy is a relatively rare disease in adults. Tuberculosis mostly involves cervical lymph nodes; however, it may involve axillary lymph nodes, mediastinal lymph nodes, or abdominal nodes secondary to pulmonary tuberculosis. Inguinal lymph node involvement in tuberculosis has been mentioned in the literature with involvement of skeletal system. Moreover, tubercular lymphadenopathy is difficult to differentiate from other causes of peripheral lymphadenopathy in the absence of pulmonary tuberculosis. The majority of the time, enlargement of inguinal nodes in the tropical countries is because of chronic infection related to bare foot walking and repeated trauma to the feet. Second possibility is of lymphatic filariasis. Inguinal lymph node is an unlikely site for primary tubercular infection and may not be clinically suspected. A high index of suspicion, in patients with peripheral lymphadenopathy, is therefore required in regions where tuberculosis is more prevalent. It is essential that a peripheral lymph node biopsy be performed and examined either histologically or microbiologically;, ^[1] however, FNAC gives positive diagnosis in most of the cases of peripheral lymphadenopathy. Dandopat MC et al., ^[2] in 1990 found 66/80(83%) cases positive on FNAC. A tuberculin skin test and contrast enhanced CT imaging are also suggested. ^[1] In the absence of complications such as sinus, ulcer or abscess chemotherapy alone gives excellent results. ^[2] Surgery is required in the presence of complications. ^[3]

Source of Support: None, Conflict of Interest: None

[Figure 1]