The treatment of superficial tuberculous lymphadenitis

Tuberculosis of the superficial lymph nodes responds well to chemotherapy, with uneventful resolution of the condition in 70% of patients. Nodes can appear afresh or enlarge during treatment but usually resolve. Fluctuation, discharge, sinus formation and scar breakdown occur in the minority. At the end of chemotherapy 10% may be left with residual nodes. After chemotherapy nodes can enlarge or appear afresh, usually transiently. Such events do not imply relapse, nor does the persistence of nodes presage relapse. Initial excision does not seem to affect outcome and surgical procedures should be reserved for the relief of discomfort caused by enlarged nodes or tense, fluctuant nodes. Nine months of rifampicin and isoniazid, supplemented by ethambutol for the first 2 months, is the current treatment of choice for tuberculous lymphadenitis. Shorter regimens are under investigation.