Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis

Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis.Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study.The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell(SFC)/106 periphreral blood monocyte cell(PBMC)according to the instruction of testing kits.The gold standard for diagnosis of TBL was the combination of microbiology results,histopathology results and patient's response to anti-TB treatment.Diagnostic efficacy of T-SPOT.TB was evaluated,including sensitivity,specificity,accuracy,predictive values,and likelihood ratio.Results Among 91 patients who met the inclusion criteria,we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up.According to the gold standard,there were 37 cases of true TBL(9 confirmed TBL and 28 probable TBL),30 cases of non-TBL,and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses.The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response.The sensitivity,specificity,accuracy,positive predictive value(PPV),negative predictive value(NPV),positive likelihood ratio(PLR)and negative likelihood ratio(NLR)of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%,66.7%,79.1%,76.7%,83.3%,2.68 and 0.16,respectively.The number of SFCs of T-SPOT.TB in TBL patients[432(134-1264)/106 PBMCs]was higher than that in non-TBL patients[0(0-30)/106 PBMCs]with a significant difference(Z=-5.306,P<0.001).Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.

IgG4-related autoimmune pancreatitis overlapping with Mikulicz's disease and lymphadenitis:A case report

Autoimmune pancreatitis(AIP)is a form of chronic pancreatitis that is categorized as type 1 or type 2according to the clinical profile.Type 1 AIP,which predominantly presents in a few Asian countries,is a hyper-IgG4-related disease.We report a case of IgG4-related AIP overlapping with Mikulicz’s disease and lymphadenitis,which is rare and seldom reported in literature.A 63-year male from Northeast China was admitted for abdominal distension lasting for one year.He presented symmetric swelling of the parotid and submandibular glands with slight dysfunction of salivary secretion for 6 mo.He had a 2-year history of bilateral submandibular lymphadenopathy without pain.He underwent surgical excision of the right submandibular lymph node one year prior to admission.He denied any history of alcohol,tobacco,or illicit drug use.Serological examination revealed high fasting blood sugar level(8.8 mmol/L)and high level of IgG4(15.2 g/L).Anti-SSA or anti-SSB were negative.Computed tomography of the abdomen showed a diffusely enlarged pancreas with loss of lobulation.Immunohistochemical stain for IgG4 demonstrated diffuse infiltration of IgG4-positive plasma cells in labial salivary gland and lymph node biopsy specimens.The patient received a dose of 30 mg/d of prednisone for three weeks.At this three-week follow-up,the patient reported no discomfort and his swollen salivary glands,neck lymph node and pancreas had returned to normal size.The patient received a maintenance dose of 10mg/d of prednisone for 6 mo,after which his illness had not recurred.

Mediastinal tuberculous lymphadenitis presenting as an esophageal intramural tumor: A very rare but important cause for dysphagia

Dysphagia associated with esophageal mechanical obstruction is usually related to malignant esophageal diseases. Benign lesions are rarely a cause for this type of dysphagia, and usually occur either as an intramural tumor or as an extrinsic compression. Mediastinal tuberculous lymphadenitis is rare in adults, and even more rarely causes dysphagia. We report two cases of dysphagia in adult patients caused by mediastinal tuberculous lymphadenitis, presenting radiologicaUy and endoscopically as an esophageal submucosal tumor. Based on the clinical and imaging diagnosis, the patients underwent a right thoracotomy, and excision of the mass attached to and compressing the esophagus. Pathological examination of the specimens showed a chronic granulomatous inflammation with caseous necrosis, which was consistent with tuberculous lymphadenitis.

Postoperative reactive lymphadenitis: A potential cause of false-positive FDG PET/CT

A wide variety of surgical related uptake has been reported on F18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography(FDG PET/CT) scan, most of which can be differentiated from neoplastic process based on the pattern of FDG uptake and/or anatomic appearance on the integrated CT in image interpretation. A more potential problem we may be aware is postoperative reactive lymphadenitis, which may mimic regional nodal metastases on FDG PET/CT. This review presents five case examples demonstrating that postoperative reactive lymphadenitis could be a false-positive source for regional nodal metastasis on FDG PET/CT. Surgical oncologists and radiologists should be aware of reactive lymphadenitis in interpreting postoperative restaging FDG PET/CT scan when FDG avid lymphadenopathy is only seen in the lymphatic draining location from surgical site.

Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review

Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

Cervical Nontuberculous Mycobacterial Lymphadenitis Mimicking a Thyroid Tumor and Infiltrating Deep into the Neck

Aim: Nontuberculous Mycobacterial Lymphadenitis (NML), which occurs in 1.2 per 100,000 children, is very rare. And those which emerge at the anterior cervical portion and infiltrate deep into the neck are even more rare. Generally, this disorder is uncommon existed near the thyroid gland. We report here a case of NML mimicking a thyroid tumor and infiltrating into the deep part of the anterior neck. Case: A mass at the anterior portion of her neck was found at 5 years old. It was not mobile and palpated as an irregularly surfaced hard mass whose size was 3 cm at the anterior lower portion of her neck. Ultrasonography showed an oval mass which existed near the slightly inferior part of the right lobe of the thyroid gland. Enhanced computed tomography showed a mass near the slightly inferior part of the right lobe of the thyroid gland. The mass was resected with the platysma and the right sternohyoid muscle. In the HE staining, epithelioid cell and Langhans type giant cells surrounding coagulative necrosis lesions which seemed to be caseation necrosis existed, similarly to cervical NML. Discussion: No consensus exists for the treatment of NML, but many documents advise complete excision. When the lesion cannot be completely removed, excision as far as possible and additional antibiotics are recommended. The characteristics of imaging of NML around the thyroid gland and infiltrating deep into the anterior neck and mediastinum are discussed.

Clinico-Demographic Characteristics of Tuberculous Lymphadenitis: Experience of 50 Cases in Bangladesh

Background: Clinical and demographic features are important for the tuberculous lymphadenitis patients for treatment. Objective: The purpose of the present study was to see the clinical and demographic features of tuberculous lymphadenitis patients. Methodology: This cross-sectional study was done at the Department of Pathology at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2009 to March 2011 for a period of nearly two years. All the patients, irrespective of age and sex with the clinical features, suggestive of tuberculous lymphadenitis and later on, proved to be the same histologically, were selected for the study purposively. Relevant information was recorded in a prescribed data sheet and histomorphological findings were recorded accordingly. In cases where fresh specimen was available, caseous portion of lymph node was sent for culture. Fite Faraco staining was also done on lymph node sections in all cases. Result: A total number of 50 tuberculous lymphadenitis patients were recruited for this study. Among this study population, the age of cases ranged from 12 years to 65 years with a mean age of 26.22 ± 2.52 years. Male and female ratio was 1:1.38. Besides lymphadenopathy, 45 patients had low grade fever;32 patients had weight loss and 18 patients had cough. Among 50 cases of lymph node tuberculosis cervical lymphadenopathy was 41 (82.0%) cases;6 (12.0%) cases had supraclavicular lymphadenopathy;2 (4.0%) cases had inguinal lymphadenopathy and 1 (2.0%) had axillary lymphadenopathy. The mean duration of presentation of lymphadenopathy with standard deviation was 7.06 ± 1.6 months. Thirty eight patients (76.0%) had lymphadenopathy for less than 12 months. Conclusion: In conclusion, young age group people are most commonly affected by tuberculous lymphadenitis with the predominance of female and most of them are presented with low grade fever and weight loss.

Histiocytic Necrotizing Lymphadenitis: A Clinical Study of 6 Children and Review

Objective: As a rare cause of fever and lymphadenopathy (especially in the neck) in children, the purpose of this study is to explore the clinical characteristics of histiocytic necrotizing lymphadenitis (HNL) in children and improve the diagnosis and treatment of this disease. Methods: We retrospectively collected the data of 6 pediatric patients with HNL diagnosed by lymph node biopsy from 2012 to 2021 in department of pediatric, the affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, including the clinical characteristics, laboratory examinations, imaging findings and histopathological examinations, treatment and follow-up of the patients and reviewed relevant literature. Results: All the patients were Han girls, with no kinship with each other, and four cases were from rural areas. The age of onset was from 7 to 14 years old, with durations ranged from 1 week to 3 months. All children had cervical lymphadenopathy with tenderness, five cases of fever, two cases of cough, one case of weight loss, four cases of leukopenia, one case of liver impairment, one case of combined bacterial infection of leukocytosis. All children underwent lymph node biopsy and were diagnosed with HNL, four children were treated with anti-infection before diagnosis, two children were treated with steroid therapy after diagnosis, and 1 case of weakened immune function was used immunoglobulin for modulating immunity. All children improved and discharged, and no recurrence was observed until October 2021. Conclusion: In our study, the children with swollen lymph nodes in the neck were accompanied by tenderness and fever as the main clinical manifestations, without specificity. Histopathology and immunohistochemical examination by removing the affected lymph nodes could confirm HNL. Most children had a good prognosis and long-term follow-up were required.

Deepgoing study on intrathoracic tuberculous lymphadenitis in adults using multidetector CT

Background Studies on intrathoracic tuberculous lymphadenitis in adults are confined to the preliminary CT findings with ordinary CT and ordinary spiral CT. There has been no deepgoing study of multidetector CT to date. Multidetector CT could contribute to better imaging of intrathoracic tuberculous lymphadenitis in adults. The purpose of this study was to explore the multidetector CT features of intrathoracic tuberculous lymphadenitis in adults, and the correlation with clinical symptoms and pathologic changes. Methods Multidetector CT findings from 42 consecutive adult patients with intrathoracic tuberculous lymphadenitis were analyzed retrospectively with regard to locations, sizes, numbers, shapes, margins, and densities reviewing precontrast and enhanced images. CT results were correlated with clinical symptoms and pathologic results （n=37）. Results One hundred and eighty-five intrathoracic lymph nodes that had tuberculous lymphadenitis in 42 patients were distributed mainly in regions 4R （n=37）, 2R （n=33）, 7 （n=31） and 10R （n=21）, more than 2 regions were implicated in 34 patients. One hundred and twenty-two （72.2%） of the tuberculous lymphadenitis without confluence were oval or round with clear margins. On precontrast scanning, 78.4% of tuberculous lymphadenitis had a homogeneous density. Seven enhancement patterns were demonstrated in 169 tuberculous lymphadenitis from 37 patients with pathologic results： homogeneous enhancement with no clinical symptom （n=12）, corresponded pathologically to tuberculous hyperplasia without caseous necrosis; heterogeneous enhancement with a small central no enhancement area, slight clinical symptoms （n=22）, tuberculous granulomas with a little caseous necroses; peripheral irregular thick wall enhancement with a central area with no enhancement, slight clinical symptoms （n=52）, tuberculous granulomas with some caseous necroses in the center; peripheral thin rim enhancement with a central area having no enhancement, moderate clinical symptoms （n=36）, a few tuberculous granulomas with a great quantity of caseous necroses in the center; peripheral irregular enhancement without central enhancement, extending outside the capsule, severe clinical symptoms （n=4）, caseous necroses ruptured from capsule; peripheral irregular rim enhancement with central separate enhancement, severe clinical symptoms （n=40）, multiple lymph nodes with liquefaction of caseous necroses were adherent and confluent, rim and separation were tuberculous granulomas; no obvious enhancement, severe clinical symptoms （n=3）. Caseous necrosis was usually associated with little tuberculous granulomas. Conclusions The main multidetector CT features of intrathoracic tuberculous lymphadenitis in adults are involvement of multiregional lymph nodes with oval or round shape and clear margins, a basically homogeneous density on precontrast scanning, multiple enhancement patterns, and they correlate closely with clinical symptoms. Multidetector CT could reveal pathological changes of intrathoracic tuberculous lymphadenitis in adults.

Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children

Background To describe sonographic characteristics of cervical tuberculous lymphadenitis(CTBL)in children,clinical infor-mation,and sonograms of 348 lymph nodes(LNs)from 57 children with CTBL were retrospectively analyzed in this study.Methods We retrospectively reviewed the clinical data and sonograms of 348 LNs from 31 boys and 26 girls with CTBL,who were confirmed by pathology or laboratory examination,at the Hangzhou Red Cross Hospital between June 2014 and December 2020.The age of the children ranged from 1 to 14 years(average 7.1±2.9 years).Results Night sweats,fatigue and loss of appetite were the most common clinical symptoms observed in children with CTBL.Unilateral LN involvements were common.Occasionally.CTBL was found in healthy children with no symptoms.On sonography,the hilus was absent or unclear in all LNs.The short-to-long axis(S/L)ratio was 20.5,and the edges were unclear in most LNs.Other accompanying findings included necrosis(47.4%),an echogenic thin layer(36.8%),surround-ing soft-tissue edema(38.5%)。multiple intra-nodal strong echo(28.2%),sinus(22.7%)and abscess formation(6.9%).The Doppler ultrasound showed that the majority of vascularity patterns of CTBL were capsular or peripheral(3.3%).Conclusions Ultrasound is a recommended examination method for children from different age groups with cervical lym-phadenitis.The ultrasonic signs of hilus absence,S/L ratio≥0.5,unclear edge,necrosis,echogenic thin layer,strong echoes and capsular or peripheral vascularity may aid in the diagnosis of cervical tuberculous lymphadenitis.

Disseminated cryptococcal lymphadenitis with negative latex agglutination test

We reported an unusual case of disseminated cryptococcal lymphadenitis in an immunocompetent host who presented with fever and lymphadenopathy, which were the only two symptoms and signs. Latex agglutination test of serum and cerebrospinal fluid （CSF） were negative, while lymph node biopsy showed Cryptococcus neoformans. A diagnosis of disseminated cryptococcal lymphadenitis was made. Then the patient was treated with amphotericin B for 15 days as initial therapy and itraconazole for 6 months as maintenance therapy respectively. The patient received re-examination per 6 months and was followed up for 2 years. Swollen lymph nodes diminished gradually, and no fever or other symptoms were found. Latex agglutination test of serum and CSF were negative throughout the follow-up period, and anti-HIV, syphilis and tuberculosis antibody were all negative.

Late recurrence in surgically managed pediatric atypical mycobacterial lymphadenitis:A case report and review of the literature

Objective:The purpose of this study is to identify existing literature on recurrent atypical mycobacterial cervicofacial lymphadenitis to augment our understanding of a unique patient who presented to our tertiary‐care center 5‐years posttreatment with recurrence following curettage.Data Sources:OVID Medline,Scopus,and Web of Science.Methods:A literature search was conducted yielding 49 original articles which were screened twice by two independent reviewers resulting in 14 studies meeting inclusion criteria for data extraction using Covidence software.Two independent reviewers extracted data on recurrence of atypical mycobacterial cervicofacial lymphadenitis and consensus was reached on data points from all included studies.Results:This study illuminated the paucity of recurrence reporting in the literature regarding atypical mycobacterial lymphadenitis.Sixteen studies identified in our review included discussions on recurrence with few elaborating beyond the rate of recurrence to describe their management.Fourteen out of sixteen studies provided recurrence rates for their cohort,11 out of 14 specified the initial treatment modality,and only five out of eight studies that described initial treatment with surgery differentiated recurrence rates between complete and incomplete excision.The mean length of follow‐up in the included studies was 20 months.There was one previously reported case of late recurrence at 5‐years.Conclusions:We identified few reports that discussed the management of recurrence of atypical mycobacterial cervicofacial lymphadenitis.There was minimal data on recurrence rates between surgical treatment modalities.The case discussed in our study showcases that treatment with curettage has the potential to present with late recurrence.

摩洛哥塔扎地区颈部淋巴结肿大42例

颈部软组织结核在我国,特别是大中城市日渐减少。回顾性分析笔者援助摩洛哥期间,颈部结核性淋巴结炎等淋巴结肿大病例42例,报道如下。1.1病例资料。回顾性分析摩洛哥塔扎省立Ibnou Baja医院2013年3月-2015年2月42例患者因颈部慢性软组织包块就诊。年龄3-75岁,男28例,女14例。1.2诊疗原则。一般长径〈2.0 cm的颈部单发淋巴结,质软、活动佳,予以临床观察。

Comparison of Histological, Microbiological, and Molecular Methods in Diagnosis of Patients with TBLN Having Different Anti-TB Treatment Background

Objective The influence of anti-tuberculosis （TB） treatment history on tuberculous lymphadenitis （TBLN） diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN. Methods In this study, suspected patients with TBLN and having different anti-T8 treatment background were enrolled. All the samples were tested simultaneously by histology, ZiehI-Neelsen （ZN） staining, mycobacterial culture （culture）, Xpert MTB/RIF （xpert）, real-time PCR, and high-resolution melting curve PCR （HRM）. Thereafter, the performance of these methods on samples with different anti-TB treatment background was assessed. Results In our study, 89 patients were prospectively included 82 patients with TBLN and 7 with other diseases. The overall sensitivities of Xpert, real-time PCR, histology, ZN staining, and culture were 86.6%, 69.5%, 58.5%, 43.9%, and 22.0%, respectively. The anti-TB treatment history revealed dramatic influences on the sensitivity of culture （P 〈 0.0001）. In fact, the treatment that lasted over 3 months also influenced the sensitivity of Xpert （P 〈 0.05）. However, the treatment history did not affect the performance of remaining tests （P 〉 0.05）. For rifampicin drug susceptibility test （DST）, the anti-T8 treatment showed only significant influence on the success rate of culture DST （P = 0.001）, but not on those of Xpert and HRM tests （P 〉 0.05）. Conclusion Other tests as welt as culture should be considered for patients with TBLN having retreatment history or over 1-month treatment to avoid false negative results.

Kikuchi-Fujimoto disease:A comprehensive review

Kikuchi-Fujimoto disease,a rare form of necrotizing lymphadenitis,is an uncommon,benign,self-limiting disorder of obscure etiology.It affects mostly young adults of both genders.Clinically,it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss,splenomegaly,leucopenia,and elevated erythrocyte sedimentation rate feature in severely affected patients.Cutaneous involvement occurs in about 30%-40%of cases as facial erythema and nonspecific erythematous papules,plaques,acneiform or morbilliform lesions of great histologic heterogeneity.Both Kikuchi-Fujimoto disease and systemic lupus erythematosus share an obscure and complex relationship as systemic lupus erythematosus may occasionally precede,develop subsequently,or sometimes be associated concurrently with Kikuchi-Fujimoto disease.It is often mistaken for non-Hodgkin lymphoma while lupus lymphadenitis,cat-scratch disease,Sweet’s syndrome,Still’s disease,drug eruptions,infectious mononucleosis,and viral or tubercular lymphadenitis are other common differentials.Fine needle aspiration cytology mostly has features of nonspecific reactive lymphadenitis and immunohistochemistry studies usually show variable features of uncertain diagnostic value.Since its diagnosis is exclusively from histopathology,it needs to be evaluated more carefully;an early lymph node biopsy will obviate the need for unnecessary investigations and therapeutic trials.Its treatment with systemic corticosteroids,hydroxychloroquine,or antimicrobial agents mostly remains empirical.The article reviews clinicoepidemiological,diagnostic,and management aspects of KFD from the perspective of practicing clinicians.

首诊为颈淋巴结炎的川崎病2例

川崎病（Kawasaki disease，KD）是以全身血管炎症为主要病变的急性、发热性、出疹性疾病，主要发生于5岁以下儿童，占全部川崎病患者的80％-85％。因川崎病早期可仅表现为发热及淋巴结肿大，容易误诊为颈淋巴结炎。

Fatality in Kikuchi-Fujimoto disease: A rare phenomenon

Kikuchi-Fujimoto disease(KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon condition, typically characterized by lymphadenopathy and fevers. It usually has a benign course; however, it may progress to fatality in extremely rare occasions. The diagnosis is made via lymph node biopsy and histopathology. Our patient was a young female who presented with shortness of breath, fever, and malaise. Physical examination revealed significant cervical and axillary lymphadenopathy. Chest X-ray displayed multilobar pneumonia. She required intubation and mechanical ventilation for progressive respiratory distress. Histopathology of lymph nodes demonstrated variable involvement of patchy areas of necrosis within the paracortex composed of karyorrhectic debris with abundant histiocytes consistent with KFD. After initial stabilization, the patient's condition quickly deteriorated with acute anemia, thrombocytopenia and elevated prothrombin time, partial prothrombin time, and D-dimer levels. Disseminated intravascular coagulopathy(DIC) ensued resulting in the patient's fatality. DIC in KFD is not well understood, but it is an important cause of mortality in patients with aggressive disease.

Inflammatory pseudotumour of the spleen associated with splenic tuberculosis

Inflammatory pseudotumor(IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirtyseven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.

Salivary duct carcinoma of the submandibular gland presenting a diagnostic challenge: A case report

BACKGROUND Salivary duct carcinoma(SDC)is a rare,extremely aggressive malignancy that arises in the submandibular gland.It can metastasize locally early and therefore is an important differential diagnosis of metastatic disease in cervical lymph nodes or specific lymphadenitis such as tuberculous cervical lymphadenitis.CASE SUMMARY We report a case of SDC in the submandibular gland that presented diagnostic difficulty.The lesion was coincidentally discovered through examination of the radiolucent area of the maxilla.Imaging failed to confirm the possibility of specific inflammation,leading us to execute an open biopsy to verify the diagnosis.The surgical specimen showed that the submandibular gland was primarily replaced with a calcified body.Following histological analysis and confirmation,we performed surgical resection,radiotherapy,and various chemotherapies.CONCLUSION Radiographic imaging characteristics of lymph node metastases of salivary gland cancer,especially of SDC,may resemble other cervical lymphadenitis;calcification at the submandibular gland is the landmark of SDC occurring at the submandibular gland.

Kawasaki disease with peritonsillar abscess as the first symptom:A case report

BACKGROUND Kawasaki disease(KD),also known as mucocutaneous lymph node syndrome,is an acute,self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications,with a 25%incidence of coronary artery aneurysms.Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever,difficulty in opening his mouth,and neck pain and was originally treated for throat infection without improvement.On the basis of laboratory tests,ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck,the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy.On the fifth day of admission,the child developed conjunctival congestion,prune tongue,perianal congestion and desquamation,and slightly stiff and swollen bunions on both feet.A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.CONCLUSION Children with neck pain,lymph node enlargement,or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics.Clinicians should not rush invasive operations such as neck puncture,incision,and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.