Tuberculous lymphadenitis: Difference between revisions

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==Background==
==Background==
*Also known as "scrofula" when involves cervical lymph nodes
*Most common form of extrapulmonary [[TB]]
*Most common form of extrapulmonary [[TB]]
*Tuberculous lymphadenitis in the cervical region is known as scrofula
*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>
*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>
*In the US, more common among Asian Pacific Islanders and in females
*Most cases occur in the setting of reactivation of latent infection
*Most cases occur in the setting of reactivation of latent infection
*In the US, more common amoung Asian Pacific Islanders and in females


==Clinical Features==
==Clinical Features==
*Enlarging, painless, red, firm, mass, most commonly in the anterior or posterior cervical chain
[[File:Tubercular adinitis with sinus.jpg|thumb|Tubercular adenitis with sinus.]]
*Can be complicated by ulceration, fistula, or abscess formation
[[File:PMC4555907 IJSTD-36-80-g001.png|thumb|Matted lymph nodes in the right inguinal region. Discharging sinus and healed scars on the left side.]]
*Systemic signs and symptoms are uncommon, except in HIV patients (in whom lymphadenitis is usually generalized)
*Enlarging, painless, red, firm, [[neck mass|mass]], most commonly in the anterior or posterior cervical chain
*Can be complicated by ulceration, fistula, or [[abscess]] formation
*Systemic signs and symptoms are uncommon, except patients with [[HIV]] (in whom lymphadenitis is usually generalized)


==Differential Diagnosis==
==Differential Diagnosis==
*[[Lymphoma]]
{{Lymphadenitis DDX}}
*Metastatic cancer
{{Neck mass DDX}}
*Fungal disease
*[[Cat-scratch disease]]
*[[Sarcoidosis]]
*[[Toxoplasmosis]]
*Reactive adenitis
*Bacterial adenitis


==Evaluation==
==Evaluation==
*Fine needle aspiration: sensitivity and specificity (77 and 93% respectively)<ref>Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.</ref>
*Excisional biopsy (if FNA is not diagnostic)
**highest diagnostic yield
**Submit specimens for histology, culture, and Nucleic acid amplification testing
**caseating granulomas on histopathology is highly suggestive of TB
*CT can be useful to identify involved lymph nodes for biopsy
*CXR: most do not have evidence of active pulmonary TB in nonendemic countries
*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref>


==Management==
==Management==
*Medical therapy
**[[Rifampicin]], [[isoniazid]], [[ethambutol]], and [[pyrazinamide]] (RIPE therapy) given daily x 2 months
**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months
*Surgical excision may be performed if medical therapy fails
*Do not I&D, can result in permanent sinuses and prolonged drainage


==Disposition==
==Disposition==


==See Also==
==See Also==
*[[Lymphadenitis]]
*[[TB]]


==External Links==
==External Links==
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<references/>
<references/>


[[Category:ID]]
[[Category:ID]] [[Category:Dermatology]]
[[Category:Dermatology']]

Latest revision as of 21:42, 9 September 2020

Background

  • Also known as "scrofula" when involves cervical lymph nodes
  • Most common form of extrapulmonary TB
  • TB causes up to 43% of peripheral lymphadenopathy in the developing world [1]
  • In the US, more common among Asian Pacific Islanders and in females
  • Most cases occur in the setting of reactivation of latent infection

Clinical Features

Tubercular adenitis with sinus.
Matted lymph nodes in the right inguinal region. Discharging sinus and healed scars on the left side.
  • Enlarging, painless, red, firm, mass, most commonly in the anterior or posterior cervical chain
  • Can be complicated by ulceration, fistula, or abscess formation
  • Systemic signs and symptoms are uncommon, except patients with HIV (in whom lymphadenitis is usually generalized)

Differential Diagnosis

Lymphadenitis

Infectious

Non-Infectious

Neck mass

Acute

Subacute (weeks to months)

Chronic

  • Thyroid nodules or cancer
  • Goiters
  • Congenital cysts
    • Branchial cleft cyst
    • Thyroglossal duct cyst- 2nd most common benign neck mass
    • Dermoid cyst
  • Carotid body tumor
  • Glomus jugulare or vagale tumor
  • Laryngocele
  • Lipoma/liposarcoma
  • Parathyroid cysts or cancer

Evaluation

  • Fine needle aspiration: sensitivity and specificity (77 and 93% respectively)[2]
  • Excisional biopsy (if FNA is not diagnostic)
    • highest diagnostic yield
    • Submit specimens for histology, culture, and Nucleic acid amplification testing
    • caseating granulomas on histopathology is highly suggestive of TB
  • CT can be useful to identify involved lymph nodes for biopsy
  • CXR: most do not have evidence of active pulmonary TB in nonendemic countries
  • Sputum smear and culture: positive only in approximately 20% of cases[3]

Management

  • Medical therapy
  • Surgical excision may be performed if medical therapy fails
  • Do not I&D, can result in permanent sinuses and prolonged drainage

Disposition

See Also

External Links

References

  1. ↑ Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.
  2. ↑ Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.
  3. ↑ Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.
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