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Not TB, What It could be?
Jan 13, 2002

Dear Doc, I found a lump before 4 months in my right arm pit. i had excisional biopsi and the pathologist said caseous granulomatous inflamation. I went to infectious deeasse specialist. He asked for tissue culture and started medication for TB (as you answered me a month ago). Now, tissue culture do not show anything. My HIV test came out to be negative.

How reliable are these tests? My only exposure was 12 yrs ago and my blood counts and chem panels and x-ray is fine. Should I be assured with the result of the HIV test?

Now, my doctor wants to do CT scan of the whole body to see if there is some thing.

I have been started with the suspicion of HIV and TB and end up with nothing. What it could be?

If lymphoma, should the patholost not found the malignant cell?

Please answer me, what do you think?

Response from Dr. Feinberg

There are other infections besides TB that can cause granulomatous inflammation such as histoplasmosis, but caseous granulomas are pretty specific for TB. The findings from your biopsy are not at all consistent with a diagnosis of lymphoma. Luckily, your HIV test is negative, and if your possible exposure was 12 years ago, then the HIV test result is very reliable. CT scan may show evidence of an abnormality at another site that can be evaluated, and is a reasonable thing to do. You may also want to have the slides from your biopsy sent to an expert pathologist for a second opinion. Good luck!


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