Tuberculous mediastinal lymphadenopathy in an adult

We describe a patient who presented to us with fever, decreased appetite, weight loss and dry cough for 1 month with no abnormalities on examination. A chest radiograph showed a mediastinal shadow. CT of the chest revealed multiple mediastinal lymph nodes. Bronchoalveolar lavage was negative for acid-fast bacilli and cytological examination did not show malignant cells. Serum ACE levels were high (93 U/L). Bone marrow aspiration and biopsy did not reveal any pathology. Mediastinoscopy-guided mediastinal lymph node biopsy showed features of granulomatous lymphadenitis. This case report summarises an unusual presentation of tuberculosis in an adult.