Not TB, Is it lymphoma? What else could I have?

Question

Dear Doc, I found a lump before 4 months in my right arm pit. I had excisional biopsy and the pathologist said caseous granulomatous inflammation. I went to infectious disease specialist. He asked for a tissue culture and started medication for TB. Now, the tissue culture does 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 pathologist not have found the malignant cell?

Answer

I just posted today a lengthy response to the query "what is caseous granulomatous inflammation?". Was that yours?

I believe your infectious disease specialist did the appropriate thing-- he started you on TB medications until the tissue culture came back negative. I agree with his plan to perform a CT scan to see if there is any clue as to why you had "caseous granulomatous inflammation". It is not that common, so (s)he is correct in trying to find out why you got it. You mention that this was from your arm pit. I can't help but wonder if you got cat scratch fever. Do you have a cat? Cats carry a certain bacteria which can cause large lymph nodes in the arm pit area after a scratch. Such a bacteria is readily treated with antibiotics.

In certain cases, we never find out the cause of the granulomatous inflammation. As for your HIV test, my guess is that it is reliable, i.e. that you are HIV negative.

If they figure out the cause of your granulomatous inflammation, please write back.