インターフェロンγ遊離試験(IGRA)が有用であった結核性頸部リンパ節炎の1例

  • 大橋 祐生
    岩手医科大学歯学部口腔顎顔面再建学講座口腔外科学分野
  • 熊谷 章子
    岩手医科大学法科学講座法歯学・災害口腔医学分野
  • 三上 俊成
    岩手医科大学病理学講座病態解析学分野
  • 星 秀樹
    青森県立中央病院歯科口腔外科
  • 杉山 芳樹
    岩手医科大学歯学部口腔顎顔面再建学講座口腔外科学分野
  • 山田 浩之
    岩手医科大学歯学部口腔顎顔面再建学講座口腔外科学分野

書誌事項

タイトル別名
  • Efficiency of the Interferon-Gamma Release Assay on the diagnosis in a patient of tuberculous cervical lymphadenitis

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説明

A 57-year-old male was referred to our department with a chief complaint of a right submandibular mass. Fluorodeoxyglucose-positron emission tomography/computed tomography revealed a lesion with abnormal FDG uptake (SUV max. 9.1) in the right submandibular region. Malignant lymphoma, cervical lymph node metastasis from an unknown primary cancer, and tuberculous lymphadenitis were suspected. Excisional biopsy of the submandibular mass was performed, and the histopathological diagnosis was epithelioid cell granuloma with necrotic tissue. Under the suspicion of tuberculosis, Ziehl–Neelsen staining was added to identify the acid-fast bacteria. Moreover, testing with sputum acid-fast bacteria staining, tuberculin reaction test, and interferon-gamma release assay were performed. The result of Ziehl–Neelsen staining was negative, and no acid-fast bacteria were detected from the sputum. However, the results of the tuberculin reaction test and interferon-gamma release assay were positive. Based on these results, a diagnosis of tuberculous cervical lymphadenitis was made. Therefore, quadruple chemotherapy including isoniazid, rifampicin, pyrazinamide, and ethambutol was started. After one year and two months from the start of the treatment, the course of the patient was uneventful without a new lesion or relapse.

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