CRA104 A MIMICKER DISGUISED AS TB LYMPHADENITIS

Sook Ling Low¹, Nurhayati Mohd Marzuki¹, Zamzurina Abu Bakar, Syazatul Syakirin Sirol Aflah¹, Nabilah Bt Salman Parasi¹, Nor Suraya Bt Samsudin¹

¹Institut Perubatan Respiratori, Kuala Lumpur, Malaysia

Introduction
Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis (TB) in both immunocompetent and immunocompromised patients. While paradoxical enlargement of lymph nodes is a well-recognized phenomenon during the treatment of tuberculous lymphadenitis, it requires a high index of suspicion to distinguish between paradoxical reaction and alternative diagnosis.

Case Report
A 36-year-old retroviral disease (RVD) male with a CD4 count of 141/μL and HIV1 viral load of 124,000/mm3 was diagnosed with extrapulmonary tuberculosis based on urine TB lipoarabinomannan (LAM). The health clinic team started him on antituberculous treatment, followed by active antiretroviral therapy (HAART) 2 weeks later. However, after one month of antituberculous treatment, he presented with new onset left mandibular swelling, progressively increasing in size, associated with pain, discharge, and night sweats. The ultrasound of the neck revealed a large left submandibular mass (6.1 x 6.7 x 4.7 cm). It prompted an excision biopsy of an enlarging lymph node, which turned out to be Burkitt's lymphoma. The lymph node biopsy for acid-fast bacilli and MTB gene Xpert were both negative. He was transferred to the hematology center for further management. His antituberculous treatment was continued while waiting for assessment with computed tomography.

Conclusion
The association of HIV infection with tuberculosis and Burkitt lymphoma is rare in the highly active antiretroviral therapy (HAART) era. Any paradoxical enlargement of lymph nodes during antituberculous treatment must be thoroughly assessed. Early recognition, diagnosis, and prompt multidisciplinary therapeutic management can significantly lower morbidity and complications.