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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Are The Chances Of Having TB With Swollen Lymph Nodes?

Fever for past 46 days (Except when i was on antibiotics, but then i had relapses)

I am from India and i have fever for the past 46 days.

Initially the fever started very mildy (99 F) and it rose to 104 F in around 10 days. My only symptom was fever, and it was mostly at night. The fever was accompanied with nigh sweating and chills. If I take a paracetamol, in 1 hour I was normal. I also had weight loss and lack of appetite.

The doctor took a lot of blood tests on me for different fevers like typhoid, malaria etc and everything came negative. Finally in an echo cardiogram, I was found to have very minimal pericardial effusion. So the doctor took that for granted and gave me a narrow spectrum antibiotic as iv (intravenous therapy) and my fever went down. But the fever reappeared again in 5 days. This time when I got admitted, the doctor found some problem in the chest X-Ray and asked for a chest CT-scan. I did that, and he found swollen lymph nodes, characteristic of tuberculosis.

So now he started taking tests for TB. The TB gold, mantoux and AFB.

The TB gold came mostly negative, the mantoux came positive (and I have a scar on my arm even now) and the AFB smear came negative. But looking at the mantoux and the CT scan, the doctor said that I have TB of lymph nodes and started treatment (INH, PZA and RMP). My fever was gone again and I was back to normal. The main thing was that I got my appetite back. I never felt hungry before I started TB medicine.

Now, my fever reappeared again after 7 days. Also this time, I have a swelling on me left neck. The doctor said that the swelling could be tonsillitis and gave me an antibiotic for 3 days. But my fever kept increasing and now it reached 104 F again with chills at times. I had an ultrasonography done today and everything was normal and no enlarged lymph node was found near my abdomen, kidney etc.

I also got a complete blood count test done today. My ESR is 15 (relatively low), CRP is 20 mg/l (high) and my haemoglobin is 12.7. Total count is 4300 cumm (normal), and platelet count is 2.5 lakh cumm. Doctor was saying that having a low ESR is a good thing, as it is too low for a dangerous disease.

My current symptoms are high fever, slight chest pain very rarely.

I will be getting a biopsy done of my neck this Monday probably and I will tell you what they say.

So tell me what are chances of my disease being tuberculosis as I got a relapse and what are the procedures I should take to find out my disease.

Thanks in advance.
Additional Details
And i had a blood test done today.
My ESR is always relatively low and CRP is always high.

ESR = 15 mm/hr
CRP = 20 mg/l
HB = 12.7 gm/dl
Total count = 4300 cumm
Platelet count = 2.5 lakh/cumm
LFT is normal

I have more test reports. If you want anything, please ask me.
Mon, 9 Feb 2015
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Pathologist and Microbiologist 's  Response
Hi! thanks for your detailed description!

My answer to your question : yes, there is more than 90% chance of tuberculous lymphadenopathy which is very common and generally multi-drug resistant now-a-days!

The diagnosis is only confirmed when the organism AFB is identified under microscope or grown in culture. therefore tests you have done are just supportive not diagnostic.

You had to go for aspiration of the lymph node and sent it for AFB / CULTURE; POSSIBLY THESE WERE NOT DONE!

Some other possibilities are acute lymphadenitis, Kikuchi disease and lymphoma!

all the best!
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What Are The Chances Of Having TB With Swollen Lymph Nodes?

Hi! thanks for your detailed description! My answer to your question : yes, there is more than 90% chance of tuberculous lymphadenopathy which is very common and generally multi-drug resistant now-a-days! The diagnosis is only confirmed when the organism AFB is identified under microscope or grown in culture. therefore tests you have done are just supportive not diagnostic. You had to go for aspiration of the lymph node and sent it for AFB / CULTURE; POSSIBLY THESE WERE NOT DONE! Some other possibilities are acute lymphadenitis, Kikuchi disease and lymphoma! all the best!