Cervical lymphadenitis is the most common head and neck manifestation of mycobacterial infections. The incidence of mycobacterial cervical lymphadenitis has increased. It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck. It remains a diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. A high index of suspicion is needed for the diagnosis of mycobacterial cervical lymphadenitis. A unilateral single or multiple painless lump, mostly located in posterior cervical or supraclavicular region can occur. A thorough history and physical examination, tuberculin test, staining for acid-fast bacilli, radiologic examination, fine-needle aspiration and PCR will be instrumental in arriving at an early diagnosis early institution of treatment before a final diagnosis can be made by biopsy and culture. It is important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols are different. Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication. Atypical infections can be addressed as local infections and are amenable to surgical therapy.
In this study, we aimed to assess the clinical, laboratory and radiological findings of vertebral involvement in brucellosis. Fourteen patients diagnosed with spondylitis and spondylodiscitis due to brucellosis were included in the study. Computed tomography, magnetic resonance imaging, or scintigraphy were used to diagnose the vertebral involvement. The control group consisted of 20 patients with brucellosis but no vertebral involvement. The clinical, laboratory, and radiological findings of both groups were compared. The prevalence of vertebra involvement in brucellosis was found to be 7.5%. Of the 14 study patients, two had thoracic, ten had lumbar, and two had both lumbar and sacral vertebral involvement. The associated pathologies were spondylodiscitis, narrowing in the intervertebral space, inflammation or abscess formation in the paravertebral soft tissue, and osteophyte formation. None of the patients had a collapsed vertebral body, angulation deformity, or inflammation in the epidural space. In conclusion, the possibility of vertebral involvement should be remembered in chronic brucellosis, particularly in elderly patients who present with back pain or tenderness over the spine. A high index of suspicion and clinical, laboratory, and radiological examinations help confirm the diagnosis of vertebral involvement.
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