A Clinical Study of the Treatment of Tuberculous Cervical Lymphadenitis

ABSTRACT

BACKGROUND: Tuberculous cervical lymphadenitis is a granlomatous lymphadenitis which is the most common extra-plumonary tuberculosis in Korea. There are several controversies about the methods and the duration for the treatment of the disease. METHODS: We have studied 208 cases of tuberculous cervical lymphadenitis which were treated at Chung-Goo Sung-Shim Hospital from January 1992 to December 1996. RESULTS: The result of the study are as follows The most prevalent age group was the third decade followed by the fourth decade. For the sexual distribution, females predominated over males by 1.9 to 1. the unilateral location was the most common one (76.2%). The most frequent lesion was on the anterior cervical triangle (28.6%) Simple excision was performed in 194 cases and incision plus drainage in 14 cases. Antituberculous medication was applied to the patients in two different groups. Isoniazid, Rifampin and Ethambutol were administered every day to the patients in one of the groups. To the other group, Pyrazinamide was additionally administered - Isoniazid, Rifampin, Ethambutol, and Pyrazinamide were administered every day. The average duration of medication for the former group was 13 months, and that for the latter group was 11 months. We experienced 17 cases of recurrence in both groups. The recurrence rate was 3.7% (4 cases) for the group with Pyrazinamide included and 13.0% (13 cases) for the other. For the patients with recurrence who were treated with the pyrazinamide, extending the medication from 6 to 12 months brought about a complete treatment for all cases. However, for the cases of recurrence in the other group, in which Pyrazinamide were not applied, only 8 cases were treated completely by 12 months after the additional administration of Pyrazinamide. Surgical treatment was performed for the remaining 5 cases, and all 5 cases were cured completely after additional antituberculous medication for 6 months. CONCLUSIONS: We conclude that the best choice for the treatment of tuberculous cervical lymphadenintis is the use of both surgical excision and antituberculous medication. In addition, the use of Pyrazinamide is recommended for the antituberculous medication.