Mediastinal lymphadenopathy in a patient with previously treated T-cell acute lymphoblastic leukaemia

Mediastinal lymphadenopathy in a patient with previously treated T-cell acute lymphoblastic leukaemia is a diagnostic problem. The differential diagnosis in an adult is sarcoidosis, metastases, lymphoma or, rarely, tuberculosis. Mediastinal lymph node involvement is uncommon in tuberculosis. In view of its relative rarity but good prognosis, it is important to distinguish tuberculous mediastinal lymphadenitis in adults from other causes of mediastinal masses.

An 11-year-old boy presented in September 1995 with bilateral cervical lymph node enlargement for 2 months and fever for 10 days. There was no significant medical or family history. On examination, he had generalised lymphadenopathy. Systemic examination was normal. He had a high white blood cell count (60 × 109/L) and a low platelet count. The diagnosis on bone marrow aspiration was T-cell acute lymphoblastic leukaemia. He was treated with the MCP-841 protocol as induction therapy,1 after which his bone marrow was reported to be in complete remission. He then underwent consolidation chemotherapy and prophylactic cranial radiotherapy and subsequently received six cycles of maintenance chemotherapy, which were completed by December 1997. He was lost to follow-up.