Introduction: Paradoxical hypertrophy is frequent in case of peripheral lymph node tuberculosis. Its management remains controversial.
Case study: We report a case of susclavicular and anterior cervical lymph nodes tuberculosis complicated by paradoxical hypertrophy after 4 months of treatment in a 59-year-old woman. The lymph node was not compressive but was limiting the cervical mobilisation. The caseum was sucking three times with a fine needle. Thereafter we performed an isoniazid injection each 24 hours for three days at three different lymph node sites. Antituberculous treatment was reinitiated for 10 months at all and lymph nodes completely disappeared without functional sequels.
Conclusion: Paradoxical hypertrophy is a frequent complication of peripheral lymph node tuberculosis. Caseum suction of the paradoxical hypertrophy with a fine needle may constitute an alternative treatment of surgery.