Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues

Eight cases of isolated peripheral tuberculous lymphadenitis occurred over a 16-month period at our institution, prompting a literature review to establish the epidemiology, clinical manifestations, and current approaches to diagnosis and treatment of this disorder. It occurs most commonly in young adult women who either are immigrants from areas where tuberculous is endemic or have histories of travel that are suggestive of exposure to Mycobacterium tuberculosis. The disease is indolent and usually presents as a unilateral painless neck mass. Constitutional symptoms are rare, except in individuals infected with the human immunodeficiency virus (HIV). The results of skin testing with purified protein derivative are invariably positive. Excisional biopsy for histopathologic and microbiological evaluations provides the highest diagnostic yield, although fine needle aspiration may be useful for HIV-infected individuals and in areas of the world with a high prevalence of disease. A 6-month course of combination antituberculous therapy is adequate for disease due to susceptible organisms. This infection may be readily diagnosed if suggestive epidemiological and clinical findings lead to expeditious tissue sampling.