Introduction

Lymphadenopathy is a common clinical finding for patients seeking dental treatment. It might be local, limited, or general1. Cervical lymphadenopathy is thought to be caused by malignancies, infections, autoimmune diseases, iatrogenic, and other miscellaneous conditions2,3. More than half of the patients examined on a daily basis are likely to exhibit enlarged lymph nodes in the head and neck area. The etiology of cervical lymphadenoplasia is varied, so treatment differs from patient to patient 4. 1E-mail: sghaier.jihed25@gmail.com 2E-mail: afef.1604@yahoo.fr 3E-mail: doc_hamdi@yahoo.fr
1
Most cervical lymphadenopathy is caused by a benign infectious etiology; nevertheless, doctors should look for a precipitating reason and examine additional nodal sites to rule out generalized lymphadenopathy.

Case Presentation

A 60-year-old female reported to the Department of oral medicine and oral surgery at the University Dental Clinic of Monastir-Tunisia with a complaint of painless swelling of 5 days duration on the right side of the neck, specifically in the jugular-carotid region, with an inflammatory aspect. The patient had diabetes and dyslipidemia and was being regularly treated and followed up by her primary care physician. No history of weight loss or difficulty in swallowing or breathing. There were no dysphagia, dysphonia, laryngeal dyspnea, or night sweats. He reported no relevant history, treatment, known allergy, alcohol or nicotine intoxication, or toxin consumption. Family history showed no recent infections. The patient presented swelling on the upper part of the right side of the neck, measuring approximately 5 × 3 cm in size. On palpation, the swelling was mildly tender, firm, nodular, and mobile with smooth intact overlying skin without any signs of inflammation or infection. Examination of the contralateral side was unremarkable. Patient consent was obtained for taking a photograph and using it for study and publication purposes [Figure 1]. [Figure 1 about here.] Intraoral examination revealed poor oral hygiene with the presence of local factors and signs of periodontitis. However, most notably, the right maxillary third molar is decayed and necrotic (fig2). [Figure 2 about here.] Panoramic radiograph revealed decayed right maxillary third molars, generalized horizontal bone loss, and endodontically treated 31, 32,33,43,45,46 with crowns [Figure 3]. [Figure 3 about here.] Thus, a differential diagnosis of cervical lymphadenopathy due to locoregional infection, toxoplasmosis, and tuberculosis was given by history and clinical examination. Results of the blood investigations included a raised C-reactive Protein (CRP) of 8.1 mg/l and raised Erythrocyte Sedimentation Rate (ESR) of 35 mm 1st hour and 73 mm 2nd hour. Tuberculin skin test (TST) was negative after exposure to smear-positive tuberculosis. An ultrasound scan of the neck showed a right-sided, ovoid, well-defined adenopathy of group III, heterogeneous, hypoechoic, with preserved fatty hilum and non-vascularized on color Doppler, measuring 19x9 mm. It is associated with infiltration and hyperemia of the surrounding soft tissues on color Doppler. No signs of necrosis and no visible calcification (fig4). [Figure 4 about here.] All the investigations were suggestive of benign Reactive adenitis of dental origin. Then, the Extraction of the third molar of the right side was performed under antibiotic coverage with a combination of amoxicillin and clavulanic acid (1000 mg twice a day). Swelling completely resolved within the first 10 days of the therapy. But treatment continued as per the protocol. After 20 days of follow-up, she was perfectly all right (fig5). [Figure 5 about here.]