TUBERCULOUS LYMPHADENITIS WITH PHLYCTENULAR KERATOCONJUNCTIVITIS AND ERYTHEMA NODOSUM. A RARE ASSOCIATION
Co-authors	
M.H. Rahman1, K. Dr. Kona Choudhury1, M. Professor Mahmuda Hassan1, T. Professor Taslim Uddin Ahmed1, A. Dr. Ashraf Uddin Ahmed1, S. Dr. Sudipta Roy1, A.R.M.L. A R M Lutful Kabir1, M. Dr. Masuma Khan1.
1Ad-din Women's Medical College Hospital, Paediatrics, Dhaka, Bangladesh.
Title of Case(s)
Tuberculous lymphadenitis with Phlyctenular keratoconjunctivitis and Erythema nodosum.  A rare association.
Background
Primary tuberculosis (TB)  are usually pulmonary, TB as cervical lymphadenitis has been reported frequently. Phlyctenular Keratoconjunctivitis (PKC) and Erythema nodosum (EN) may rarely be associated with this, but usually found separately. In the recent past we have not found any case report with these association which prompt us to present this case.
Case Presentation Summary
An eight years girl presented with low grade evening rise of temperature for three months, swelling of right mandibular area for two months, some red colored painful lesion on shins and continuous watering and redness of both eyes for last fifteen days. She lived in the dormitory where she exposed to a TB patient six months ago.

On examination, the child had cervical lymphadenopathy in  right jugulodigastric node (2.5×2.5 cm) , soft, rounded, non-tender and matted without any discharging sinus. Other Lymph nodes were not palpable. Eye showed bilateral PKC. Skin survey revealed EN on both shins.
Other systemic examinations were normal. CBC was normal,  ESR 49 mm in1st hour. Chest X-ray was normal, MT was 28mm. FNAC lymph nodes showed features of TB. Gen Xpert was positive. Diagnosis of primary TB  was made and started anti tubercular drugs with isoniazide, rifampicin, pyrazinamide and ethambutol for two months followed by isoniazide and rifampicin  another four months. EN and PKC disappeared within two weeks. Lymph nodes become normal within five months treatment.  
    

Fig: A. Phlyctenular keratoconjunctivitis.  B. Erythema nodosum. C. MT 28mm. D. Lymphadenopathy 
Learning Points/Discussion
Matted firm, non-tender cervical lymphnode in a child is suspicious of tubercular  origin, if it is associated with EN  it is highly suspicious  and if EN and PKC are present it is highly suggestive of tuberculosis.

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