A 25-year-old woman from Pakistan presents with a painless, fluctuant swelling in the anterior triangle of the neck. FNA reveals caseating granulomata...

Question

A 25-year-old woman from Pakistan presents with a painless, fluctuant swelling in the anterior triangle of the neck. FNA reveals caseating granulomata with Langhans giant cells. GeneXpert of the aspirate is positive for M. tuberculosis, fully sensitive. She is otherwise well with a normal chest X-ray. After completing 6 months of standard treatment, the lymph node enlarges paradoxically. What is the most likely explanation?

Accepted Answer

Paradoxical upgrading reaction (immune-mediated response to mycobacterial antigens released from killed organisms)

Answer

Treatment failure requiring second-line drugs

Answer

Drug-resistant TB missed on initial testing

Answer

Lymphoma

Answer

Reinfection with a new TB strain

uk-dtmh MCQ (SBA): Paradoxical Reaction in Lymph Node TB