Tuberculous lymphadenitis in a dialysis patient diagnosed by 18-fluorodeoxyglucose positron emission tomography and IFN-γ release assay

摘要

A 75-year-old woman on maintenance dialysis therapy developed a low-grade fever of unknown origin and general fatigue. A tuberculin skin test returned negative results, and full investigation, including a complete physical examination, chest x-ray, blood and urine cultures, antinuclear antibody, and computed tomography of the chest and abdomen, did not reveal anything unusual. An interferon gamma (IFN-gamma) release assay returned positive results, which suggested active tuberculosis (TB). An 18-fiuorodeoxyglucose positron emission tomographic (FDG-PET) scan was obtained, and it demonstrated a focus of inflammation in a lymph node located in the right chaicular fossa (Fig 1A). Because the patient refused an invasive diagnostic procedure, antituberculous therapy with isoniazid, rifampicin, and pyr-azinamide was started for a presumed diagnosis of TB.