[Rational diagnostic strategy for tuberculous lymphadenitis]

To examine the clinical, radiographic and laboratory findings in patients with tuberculous lymphadenitis and to analyse the investigational strategies which lead to the diagnosis of tuberculous lymphadenitis.

Retrospective study including 16 HIV-negative patients at the Cantonal Hospital, Winterthur with tuberculous lymphadenitis diagnosed between 1994 and 1999.

The majority of patients presented with local symptoms and without signs of severe systemic disease. All the PPD skin tests performed were positive. Cultures for M. tuberculosis were more often positive using fine-needle aspiration than surgical biopsy. We found a lack of systematic diagnostic strategy.

We suggest a standardised investigation procedure. When tuberculous lymphadenitis is suspected, the first diagnostic step consists of a PPD skin test and fine-needle aspiration for acid fast smear, mycobacterial culture and cytology. Surgical biopsy should be done if the cytological and mycobacteriological results of fine-needle aspiration are not diagnostic.