Unusual Causes of Adenopathy in a Tropical Environment: About 3 Observations

Abstract

Introduction: The discovery of peripheral lymphadenopathy is a frequent reason for consultation and hospitalization in Internal Medicine. The aim of this article is to review through three cases the etiologies of chronic lymphadenopathy rarely reported in a tropical environment. Observations: The first patient is a 62-year-old man who has been infected with HIV-1 for 14 years and who had a multicenter form of Castleman disease. The diagnosis was confirmed after 3 histological lymph nodes. The progression was favorable under Etoposide-based chemotherapy. The second observation is about a 38-year-old woman with a 2-month chronic febrile adenopathy without improvement after anti-tuberculosis treatment. The diagnosis of Kikuchi Fujimoto disease, in its necrotizing form, was confirmed in histology. The evolution was made favorable by the corticosteroid therapy. The third observation is about a 63-year-old woman with an enlargement of groups of lymph nodes, liver, and spleen. This tumoral syndrome was associated to an exudative ascites and a Systemic Inflammatory Response Syndrome (SIRS). The initial diagnosis was a multifocal tuberculosis based on a set of evidence (exudative lymphocytic ascites, epidemiological context and a positive Quantiferon TB test). The first ganglionic histology was not contributory. It was the second ganglionic histology that indicated the diagnosis of lymph node plasmocytoma revealing a myeloma. The patient died of septic shock. Conclusion: In tropical environment, the etiologies of chronic lymphadenopathy are not limited to tuberculosis and malignant haemopathies. Carrying out ganglionic histology is an absolute necessity.