Background: Diagnosis of tuberculous lymphadenopathy without paranchymal lung involvement in adults is a challenging problem for clinicians.
Case Report: A 54 year old woman referred to our center with fever and left sided axillary, cervical and supraclavicular masses since one month ago. She also gave a history of malaise, anorexia, weight loss, and night sweats. A PPD skin test was strongly positive and sputum examination for
acid-fast bacilli by direct smear and culture was negative for three times. Chest X ray revealed bilateral hilar adenopathy and CT scan showed multiple lymphadenopathy in various parts of mediastinum without paranchymal abnormality or pleural effusion. Fiberoptic bronchoscopy was not diagnostic. Histopathological findings of the surgical specimen obtained by biopsy were
consistent with the diagnosis of tuberculosis (TB). Our patient was completely cured 6 months after the initiation of anti TB treatment regiment.
Conclusions: As supported by the present report, beside to PPD skin test, radiographic studies, bronchoscopy, and clinical judgment, direct peripheral lymph node biopsy and histopatological findings have an important role in diagnosis of TB in patients with peripheral and mediastinal lymphadenopathy
without paranchymal involvement.

Keywords: Lymphadenitis, Mycobacterium tuberculosis, Immunocompetent host