Shinshu M ed J, 60⑸ :257〜259, 2012

Tuberculous Cold Abscess in the Axillary Lymph Nodes
Takuhiro YOSHIDA , Ko‑ichi TAZAWA , Eriko KASUGA
Akihiko YOSHIZAWA and Shu‑ichi IKEDA
1） Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
2） Department of Laboratory Medicine, Shinshu University Hospital

Key words:tuberculous lymphadenitis, pericarditis, cold abscess, axillary lymph node

A 56‑year‑old woman was admitted to theThe abscess was located next to the skin and wasregional medical center suﬀering from dyspnea.Sheon the verge of collapse. In case of collapse, there

was diagnosed with tuberculous pericarditis andwas the risk of nosocomial transmission, so wewas treated with antituberculous drugs (INH,RFP,selected needle aspiration. Aspirated ﬂuid revealed

EB, and PZA). One month later, her cardiac condi-

yellow pus (Fig. 3 A) which contained acid‑fasttion was ameliorated and she was discharged. Sub-bacteria (Fig. 3 B), though the subsequent culture

sequently EB and PZA were stopped. Two months

revealed no growth of those.A diagnosis of tubercu-later, she started to suﬀer from painful swelling of

lous cold abscess was made. Two weeks after thethe left axillary lymph nodes.Although her cardiac

aspiration,the abscess swelled and collapsed.It wascondition was stable, the size of the lymph nodes

surgically resected and she received an additional

was gradually enlarged (Fig. 1 A). CT and FDG‑

antituberculous medication (SM)because the lesions

PET showed a few translucent lymph nodes (Fig.2

seemed to extend into neighboring lymph nodes inA) and there was no sign of other malignancy.

spite of medication with INH, RFP and EB. Three

Because the swelling of the lymph nodes progressed

months after the surgical procedure, the abscessin spite of the amelioration of pericarditis, theswelled again and broke forming a ﬁstula (Fig.1 B),

etiology was assumed to be neoplastic or autoim-with the histology typical of a granuloma (Fig.3 C).

mune in nature. She was therefore referred to ourWith dailylavage through the ﬁstula and continuous

hospital.On admission,she was afebrile and had nouse of antituberculous drugs,her tuberculous lymph

symptoms except for the swelling of a left axillarynode lesions were completely cured 6 months after

lymph node, which was approximately 4 cm inthe last collapse.Although the lymph nodes are thediameter,elastic and partially reddish.Blood exam-

most common sites of extrapulmonary tuberculo-

ination revealed a slight inﬂammatory reaction

sis ,tuberculous cold abscess in lymph nodes is less

(CRP 0.14 mg/dl, ESR 13 mm/hr). Contrast enhan-frequent in Japan .This case suggests that tubercu-

ced CT showed a consistent low density area sur-lous lymphadenitis is an important diﬀerential diag-rounded by a ring‑enhancing lesion (Fig. 2 B). The

nosis in examining lymph node swelling and that itstumorʼ
s elasticity and CT ﬁndings suggested that

progression is not always parallel to the exacerba-

the swelling was an abscess and EB was resumed.

tion of other tuberculous disease conditions.

Corresponding author:Takuhiro Yoshida
Department of Medicine (Neurogy and Rheumatology),
Shinshu University School of Medicine, 3‑1‑1 Asahi,
M atsumoto, Nagano 390‑8621 Japan

No. 5, 2012

257Yoshida.Tazawa.Kasuga et al.

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Fig. 1
A :Swelling of the left axillary lymph node.
B :A ﬁstula formed three months after the surgical procedure.

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Fig. 2 FDG‑PET (A)and CT (B)showing a few lymph nodes in the left axilla.

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Fig. 3 The aspirated yellow pus (A) which contained acid‑fast bacteria (B). C : Histology of thecollapsed lymph node, which was typical of granuloma.
258

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Tuberculous cold abscess in the axillary lymph nodes

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