Clinical Pleomorphism ~ Tuberculosis
Extra Pulmonary Tuberculosis can manifest in a variety of clinical presentations.
It can present as a single cervical lymph nodular enlargement.
It can present as multiple discrete cervical lymph nodular enlargement.
It can present as multiple matted cervical lymph nodular enlargement.
It can present as matted lymph nodular enlargement with either uniform or variable consistency.
It can present as a cold abscess.
It can present as a collar stud abscess.
It can present as multiple sinuses in neck.
Hence tuberculosis is said to exhibit Clinical Pleomorphism.
In surgery, many wrong terms are used and is considered to be right. Some are normal saline instead of isotonic saline, pathology for disease ("no pathology detected in the xray or abdomen"),etc etc. Similarly, cold abscess is being misquoted many areas even in text books including "Surgical Pearls". Actually, cold abscess is an abscess which is occurring in a distal place from the activity of the disease. For example, in Thoracic vertebral tuberculosis, the pus can track along the intercostal nerve and appear anteriorly along one of the two branches. Here the activity is away and the pus has no characteristic features of inflammation. The caseation necrosis that occur in tuberculous lymphadenitis is not cold abscess. It is the stage of caseation necrosis.
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