[Diagnosis and therapy of lymph node tuberculosis]

Due to an increase of lymph node tuberculosis and associated diagnostic problems the question for the easiest and most accurate diagnostic measures was asked. Furthermore, the success of surgical and pharmacologic treatment was evaluated. A total of 16 patients (nine females, seven males) treated at the medical outpatient clinic between 1977 and 1995 because of lymph node tuberculosis were evaluated retrospectively. Diagnosis had been established in all cases either by fine needle aspiration or surgical excision. The mean age was 31 years (range 17-68). In 10 patients cervical lymphomas were found. Other localisations were supraclavicular, inguinal, axillary and mediastinal. In 94% of the patients a fine needle aspiration was performed to ascertain diagnosis. Acid-fast bacilli were found in 36% and mycobacteria were cultured in 92%. Five patients (31%) had a surgical excision with acid-fast bacilli in two and positive cultures from all specimens. All patients had chemotherapy, in most cases started by a combination of three and followed by a combination of two drugs. According to our results a fine needle aspiration is justified as a first diagnostic step if lymph node tuberculosis is suspected. A positive result can be regarded as conclusive and spares surgical intervention. Since negative results do not exclude tuberculosis they justify surgical excision for final diagnosis.