Table 1A.
Case | Geographical origin | Symptoms/lesions | Radiology | FNA | Histopathology | Bacteriology | IGRA (BoPPD/ AvPPD) |
---|---|---|---|---|---|---|---|
1 | Märstetten, Thurgau | Generalized enlarged LN, multiple subdermal skin nodules | n/a | LN: numerous (60%) mature lymphocytes and moderate (20%) neutrophils partly degenerated | Skin nodule: high degree pyogranulomatous panniculitis; LN: lymphadenitis, no AFB by ZN staining | AFB in ZN staining, positive MTBC real-time PCR, M. microti in culture (6 weeks) | 0.50/0.246 |
2 | Wolfhausen, Zurich, originally from eastern Europe | Enlarged mandibular LN, respiratory symptoms | Radiography: severe increase of pulmonary opacity, severe bronchial-interstitial pattern; CT: severe, generalized increase in pulmonary attenuation | LN: activated macrophages indicating a pyogranulomatous inflammation (low cellularity of the smear) | LN and lung: granulomatous inflammation with intralesional AFB | Curved AFB in ZN staining, positive MTBC real-time PCR, M. microti in culture (4 weeks) | n/a |
3 | Fieschertal, Valais | Enlarged mandibular LN, ulcerative skin lesions | CT: severe mandibular and retropharyngeal lymphadenopathy, miliary pulmonary pattern | LN: numerous lymphatic cells, mainly small lymphocytes and moderate (10–20%) neutrophils without degeneration | LN: massive chronic granulomatous to pyogranulomatous lymphadenitis, no AFB by ZN staining | Curved AFB in ZN staining, positive MTBC real-time PCR, bacterial species identification by HRM, no growth of M. microti | 7.82/2.96 |
LN, lymph nodes; AFB, acid fast bacilli.