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Lymphadenopathy (LD) is a common clinical presentation in outpatient departments (1–3). It is a cause of concern for the patient and physician alike even in the absence of symptoms (4). In India and some other developing countries, tuberculosis (TB) is the first differential diagnosis for a patient who presents with chronic lymph node enlargement (4–6). Nonetheless, studies have shown that more than 50% of cases of LD are due to non-TB causes and, in these cases, excision biopsy (EB) with histopathology and/or microbiological examination, is the only way to exclude TB (2, 5, 7). Malignancies may account for about 1% of cases of LD (1). The causes of LD can be broadly classified as shown below (8–10): Malignancy: lymphoma, acute lymphoblastic leukemia, acute promyelocytic leukemia, and metastasis.Infection: TB, streptococcal infection, pediculosis, measles, chickenpox, infectious mononucleosis, HIV, toxoplasmosis, and Taenia.Autoimmune: systemic lupus erythematosus, serum sickness, juvenile idiopathic arthritis, and rheumatoid arthritis.Drugs: phenytoin, cotrimoxazole, allopurinol, atenolol, penicillins, etc.Miscellaneous: sarcoidosis, storage disorders, histiocytosis, cystic fibrosis, and hypothyroidism.Of the various causes in adults, lymphoma and HIV infection should be ruled out in inconclusive cases (5). A retrospective analysis of 5 months data from a South African Lymphoma Clinic showed that out of 21 patients of lymphoma, 18 were mistakenly diagnosed as TB in the 12 months preceding the histological confirmation of lymphoma (11). Of the different types of lymphomas, the most common is “diffuse large B cell lymphoma” followed by “follicular lymphoma” (FL) (12, 13). FL is the most common indolent lymphoma (14). An early diagnosis of FL has become important in the light of availability of treatment options that can delay disease progression. LD due to FL and TB has a lot of similarities and differences. The article describes them with the objective of creating more awareness about FL enabling its early diagnosis. The presenting symptoms of FL are subtle, if any, and hence can be missed easily until disease progression to a more aggressive form (15–17).

Lymphadenopathy: Differentiation between Tuberculosis and Other Non-Tuberculosis Causes like Follicular Lymphoma