Clinical features and predictors of a complicated treatment course in peripheral tuberculous lymphadenitis

There remains uncertainty regarding the treatment strategy for patients with peripheral tuberculous lymphadenitis (pTBL) in areas endemic for tuberculosis. The purpose of this study was to demonstrate the clinical features and assess the predictors of a complicated treatment course in pTBL.

A retrospective analysis of 97 pTBL patients from January 1995 through to December 2004 was conducted. Patient characteristics with and without a complicated treatment course, defined as prolonged treatment (>9 months) and/or relapse, were compared for determining the predictors.

The disease occurred predominantly in females (57.7%) with a mean age of 37. Most patients (72%) were asymptomatic. Cervical nodes were the most common (72%) manifestations. Fifty-six patients completed a 6-9 month course of therapy without relapse; 28 had a prolonged but complete treatment course, and 13 relapsed within a mean of 8.5 months after treatment (range, 3-42 months; median, 7.8 months). Of 97 pTBL patients, six had enlarged or newly appeared lymph nodes during treatment. Multivariate analysis indicated that low body mass index and bilateral cervical nodes were independent determinants of a complicated treatment course with the odds ratios of 1.2 (95% CI, 1.01-1.41; p=0.042) and 3.9 (95% CI, 1.08-14.0; p=0.038), respectively.

This study found that pTBL is more likely to occur in young female patients. For patients who present with bilateral cervical nodes and low body mass index, a prolonged treatment course to ensure disease control should be considered.