Journal of Surgery 2017; 5(2): 18-21 http://www.sciencepublishinggroup.com/j/js doi: 10.11648/j.js.20170502.12 ISSN: 2330-0914 (Print); ISSN: 2330-0930 (Online) Separated Axillary Tuberculous Lymphadenitis: A Case Report Samer Makki Mohamed Al-Hakkak Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq Email address: Sammerhakak1971@yahoo.com To cite this article: Samer Makki Mohamed Al-Hakkak. Separated Axillary Tuberculous Lymphadenitis: A Case Report. Journal of Surgery. Vol. 5, No. 2, 2017, pp. 18-21. doi: 10.11648/j.js.20170502.12 Received: March 3, 2017; Accepted: March 14, 2017; Published: March 27, 2017 Abstract: Tuberculosis (TB) still accounts for a high burden disease. It has been estimated that one third of the world population is infected with Mycobacterium tuberculosis, the most residing in developing countries. Separated axillary tuberculous lymphadenopathy is rare and described in patients without proof of previous or outstanding tuberculosis anywhere in the body. TB was supposed to be considered in the differential diagnosis of patients who present with axillary lymphadenopathy, especially in the endemic areas of Tuberculosis. Ultrasonography features of the axillary lymph node in our patient were not as helpful in diagnosis as the biopsy of the lymph node. Axillary tuberculous lymphadenitis diagnosis depends on the complete pathological examination. It remains both diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. Diagnosis is difficult often requiring biopsy. Keywords: Separated, Axillary Lymphadenopathy, Tuberculosis, Ultrasound, Biopsy 1. Introduction Extra pulmonary TB accounts for about 7-30% of TB cases and lymphadenitis accounts for 17-43% of cases. Cervical lymph nodes constitute the most common site of involvement with axillary nodes affected in 3.8-20.3% of tuberculous lymphadenitis [1, 2]. Isolated axillary tuberculous lymphadenitis is rare and described in patients without previous or active pulmonary TB and no evidence of the origin of TB detected elsewhere [3, 4]. Tuberculous lymphadenitis presents as a painless, slowly progressive swelling of a single group of nodes and in 85% of cases involvement is unilateral [5]. It may resemble breast carcinoma or exist both at the same time resulting in diagnostic and therapeutic challenges [1, 6]. Confirmation of diagnosis is by histology [4]. Tuberculous lymphadenitis is a local manifestation of the systemic disease. [7] It may occur during primary tuberculous infection or as a result of reactivation of dormant foci or direct extension from a contiguous focus. Primary infection occurs on initial exposure to tubercle bacilli. Inhaled droplet nuclei are small enough to pass muco-ciliary defences of bronchi and lodge in terminal alveoli of lungs. The bacilli multiply in the lung which is called Ghon focus. The lymphatics drain the bacilli to the hilar lymph nodes. The Ghon focus and related hilar lymphadenopathy form the primary complex. The infection may spread from primary focus to regional lymph nodes. From the regional nodes, organism may continue to spread via the lymphatic system to other nodes or may pass through the nodes to reach blood stream, from where it can spread to virtually all organ of the body. Hilar, mediastinal and paratracheal lymphnodes are the first site of spread of infection from the lymphatic drainage routes for the lung parenchyma. [8] Cervical tuberculous lymphadenitis may represent a spread from the primary focus of infection in the tonsils. [9, 10] Axillary tuberculous lymphadenitis is rare and has major prevalence between 20 and 50 years old. 2. Case Report A case report of a 45-year-old female who presented in the outpatient clinic with a history of swelling in the left axilla of 6 months duration. The swelling gradually increased in size and was painless. There was no history of constitutional symptoms like low grade fever night sweat no cough, anorexia or drenching; no breast changes or left upper limb lesions. Examination revealed a female in good health, left axillary swellings that measured about