Tuberculous Lymphadenopathy in Adults: a Review of 35 Cases

Abstract

We retrospectively reviewed clinical, diagnostic, therapeutic and prognostic features of 35 patients (25 female, 10 male, mean age: 33 years, range: 16-70) with tuberculous lymphadenopathy (TB LAP) which had been followed since 1980. The diagnosis was established by tissue sampling in 32 cases (caseating granulomatous adenitis in 89%) or presence of acid-fast bacilli (AFB) in the aspirate in 2 cases and in the drainage in 1 case. Paraffin-embedded granulomatous tissues were stained by Ehrlich-Ziehl-Neelsen (EZN) and also Mycobacterium tuberculosis DNA was studied by polymerase chain reaction (PCR) (n = 21). The patients were admitted with enlarging LAP (34%), draining LAP (9%), and both systemic complaints and enlarging LAP (57%). Cervical lymph nodes were the most frequently involved site (77%). Pathologic findings on chest X-ray were seen in 23%. Erythrocyte sedimentation rate (ESR) was higher than 100 mm/hour in 25% and associated with systemic complaints. Tuberculin skin test was positive in 91%. AFB could not be seen in any granulomatous tissue (n: 21), but PCR study was positive in 33% (7/21). All patients were given anti-TB treatment (INH,RMP,EMB and/or PZA). Surgical excision of draining LAP with surrounding inflammatory tissues in addition to the medical treatment was needed in 2 cases. Clinical improvement was obtained within 3 months of the treatment and ESR returned to normal within 5 months. After completion of the treatment, 22 patients were followed-up; mean duration was 3 years, and none relapsed. In conclusion, a patient with TB LAP generally presents with a few small, painless, cervical lymph nodes, which are slowly enlarging. For exact diagnosis, excisional biopsy for histologic and microbiologic studies is essential. Use of anti-TB drugs is the main therapeutic option.

Delays in the Diagnosis and Treatment of Tuberculous Lymphadenitis in Low-Incidence Countries: A Systematic Review

“…Mert et al [23] demonstrated a delay between development of TBLA and admission from 15 to 730 days among 35 Turkish TBLA cases. No mean value was reported.…”

“…The case definition of TBLA was inconsistent in the different studies with specimens examined with microscopy, culture, polymerase chain reaction, and pathology, and/or cases based on clinical assessment. Most samples were collected using fine-needle aspiration (FNA) and/or excisional biopsy [19, 20, 23-29]. A single article had no information on the type of biopsy [21], while another study used bronchoalveolar lavage fluid, lumbar puncture, paracentesis of ascites fluid, and surgically obtained abdominal biopsies [22].…”

Head and neck fistulas of congenital or infectious etiology: retrospective analysis of 23 cases

“…The lymph nodes can be infected by Mycobacterium through hematogenous route or by a local extension from tuberculous infection of adenotonsillar tissue. [13] Thyroglossal duct cysts are the most common congenital neck masses with a typical presentation as a painless cystic mass or fistula in the region of hyoid bone at or near the midline. Due to the process of embryogenesis, thyroglossal duct cysts can be found at the base of the tongue to the lower midline of the neck.…”

Duodenal ulcers preceding cervical tuberculous lymphadenitis

“…Lymphadenitis is the most common presentation of extra pulmonary TB (1,2) and the cervical lymph nodes are most frequently involved (3). In the developing world, TB is responsible for up to 43% of the peripheral lymphadenopathy (4).…”