Factors predicting outcome in cervical lymph node tuberculosis: insights from a Tunisian case series

Tuberculosis remains a significant public health issue in Tunisia. This study aimed to describe the epidemiological, clinical, and therapeutic characteristics of cervical lymph node tuberculosis and identify factors influencing outcomes.

A retrospective study was conducted over a 3-year period in the ENT department at La Rabta Hospital, Tunis. Diagnosis was based on histopathological evidence, and disease progression was categorized as favorable (treatment <9 months, no additional surgery) or unfavorable (treatment >9 months and/or supplementary surgery).The study population was divided into two groups based on the outcome nature, and analytical analysis was performed to assess factors influencing outcomes.

The study included 102 patients (32 men and 70 women), with a median age of 34.5 years (range: 8-83 years). Most patients (78.4%) had no significant medical history or known HIV infection. Thirty-nine patients (38.2%) had a history of consuming raw milk. In 65 cases (63.7%), lymph node size exceeded 3 cm. Hypoechogenicity (53.9%) and necrosis (40.1%) were the most common findings on ultrasound and CT scan, respectively. The initial diagnostic approach included adenectomy (56.8%), lymph node dissection (8.9%), and drainage of cold abscesses (34.3%). All patients received an initial four-drug antituberculosis regimen. Ethambutol treatment was extended beyond 2 months in 65 cases (63.7%). Fifty-six patients (54.9%) had a favorable outcome.Factors associated with a favorable outcome included intact skin, complete initial lymph node dissection, favorable progress at 2 months, and prolonged ethambutol therapy.

The management of lymph node tuberculosis remains challenging, especially with insufficient bacteriological confirmation. Regional epidemiological factors should be considered. The role of surgery is crucial; however, further standardization is needed to optimize patient outcomes.