Tuberculous lymphadenopathy: a collective review with a case report

A collective review of tuberculous lymphadenopathy is presented with respect to incidence, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and treatment. A typical case report is also presented. A thorough history and physical examination, a purified protein derivative (PPD) skin test and acid-fast bacillus (AFB) stains, and histopathology of the node may provide useful information. Positive culture results are the only means of confirming the diagnosis and for distinguishing between tuberculous and non-tuberculous mycobacteria. Treatment, at least initially, must be guided by the physician's clinical suspicions.Although there remains debate as to what is the best method of treating mycobacterial lymphadenopathy, chemotherapy is essential. Excisional biopsy is recommended when feasible. The possible exception is when the diagnosis of mycobacterium tuberculosis is suggested by constitutional symptoms, characteristic chest x-ray findings, a positive PPD skin test, and positive culture of mycobacterium tuberculosis from another source such as sputum or gastric washings. This needle aspiration for diagnosis is applicable as done in the case report patient. Surgery is, therefore, reserved for excisional biopsy to establish the diagnosis if systemic disease is not suspected, and also for removal of grossly enlarged nodes. Incisional biopsy should be avoided if possible, as it can result in the formation of fistulous tracts.