CRA58 MIMICKING MALIGNANCY: DISSEMINATED TUBERCULOSIS WITH NECROTIZING LYMPHADENITIS AND SUSPECTED CNS INVOLVEMENT IN A YOUNG FEMALE

Nor Hatif Azmi, Ummi Nadira Daut, Tasnim Abdul Aziz

Medical Department Medicine Faculty, University Putra Malaysia, Serdang Malaysia.

Introduction
Tuberculosis (TB) is a well-known "great mimicker," capable of presenting with signs and imaging features suggestive of malignancy. Disseminated TB, especially in immunocompetent individuals, can closely resemble lymphoma due to widespread lymphadenopathy, bone lesions, and systemic symptoms. In TB-endemic regions, distinguishing TB from malignancy is critical to avoid inappropriate treatment and to ensure full recovery.

Case Report
A 21-year-old previously well female presented with persistent right neck swelling and intermittent low-grade fever. Examination revealed palpable cervical lymph nodes without neurological deficits or hepatosplenomegaly.
 CT of the thorax, abdomen, and pelvis revealed a right paratracheal mass (4.0 x 2.9 x 5.6 cm), multiple enlarged mediastinal and para-aortic lymph nodes, and a lytic lesion at the left ischium. MRI brain showed bilateral frontal bone erosions, raising suspicion for metastasis or hematologic malignancy such as lymphoma.

A right cervical lymph node biopsy demonstrated necrotizing granulomatous lymphadenitis with epithelioid histiocytes, multinucleated giant cells, and central caseation. No malignant cells were identified. Serum protein electrophoresis showed a polyclonal increase in gamma globulins without paraproteinemia. The overall findings were not supportive of malignancy and were more consistent with TB. The patient was diagnosed with disseminated TB and was commenced on AKURIT-4 with pyridoxine.

Discussion
This case highlights how extrapulmonary TB can mimic malignancy both clinically and radiologically. Histopathology remains the gold standard for diagnosis. In young, immunocompetent patients from endemic areas—especially when biopsy shows necrotizing granulomas—TB must remain high in the differential, even in the presence of lytic bone lesions or suspected CNS disease.