Cervical tuberculous lymphadenitis: diagnosis and demographics, a five-year case series in the UK

Introduction Cervical tuberculous lymphadenitis is a low-volume condition in the UK with a potential for delayed diagnosis. This study describes typical demographic and clinical features of patients diagnosed with cervical tuberculous lymphadenitis in a UK population. The utility of cytological, histological and microbiological investigations is reviewed with comparison between fine-needle aspiration and open biopsy. This information can facilitate recognition of new cases and guide initial management. Methods Patients diagnosed with cervical tuberculous lymphadenitis between January 2009 and December 2013 at two district general hospitals were identified from local infectious disease databases. Retrospective case-note review was undertaken to collect demographic and diagnostic data and associated complications. Results Full data were available for 51 patients aged 19-70 years (mean 32.4 years) with mean follow-up of 370 days; 49/51 patients were immigrants to the UK with a wide geographic spread in the countries of origin and time since arrival; 42/51 had no significant comorbidities, although two patients had coexistent HIV infection. The clinical presentation was most frequently without constitutional symptoms (39/51) and often with no history of tuberculosis contact. Posterior triangle neck nodes were most commonly involved (26/51). Conclusion The 'typical' patient with cervical tuberculous lymphadenitis in our region is a young healthy individual who came to the UK from a high-risk country several years earlier. Diagnosis by fine-needle aspiration is as effective as open biopsy if fluid/pus is aspirated. Open biopsy is potentially associated with complications but does not appear to increase chronic wound discharge rates in our series.