Question:medium
An 11-year-old boy presented with cough for 15 days. On examination he was found to have cervical lymphadenopathy. Lymph node examination showed the finding below. What could be the diagnosis?
An 11-year-old boy presented with cough for 15 days. On examination he was found to have cervical lymphadenopathy. Lymph node examination showed the finding below. What could be the diagnosis?
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A granuloma with central caseous necrosis and Langhans giant cells has one classic cause.
Updated On: Jun 23, 2026
- Leprosy
- Sarcoidosis
- TB
- Syphilis
Show Solution
The Correct Option is C
Solution and Explanation
Start from the histology buzzword. A granuloma whose center has soft, structureless caseous necrosis, ringed by epithelioid cells and Langhans giant cells, is the signature of tuberculosis. Add the clinical frame, an $11$-year-old with weeks of cough and cervical node enlargement (scrofula), and TB becomes the obvious read.
Run the differentials by their granuloma type. Sarcoidosis makes tidy non-caseating granulomas with no necrosis, so the presence of caseation excludes it. Leprosy granulomas track along nerves and carry acid-fast bacilli, while tertiary syphilis forms plasma-cell-laden gummas with obliterative endarteritis. None of these show the central caseation seen here.
Hence the diagnosis is $TB$, option (c).
Run the differentials by their granuloma type. Sarcoidosis makes tidy non-caseating granulomas with no necrosis, so the presence of caseation excludes it. Leprosy granulomas track along nerves and carry acid-fast bacilli, while tertiary syphilis forms plasma-cell-laden gummas with obliterative endarteritis. None of these show the central caseation seen here.
Hence the diagnosis is $TB$, option (c).
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