Tuberculous lymphadenopathy: an approach to diagnosis and management

ABSTRACT

The aim of the study is to determine the incidence of peripheral tuberculeus lymphadenopathy in western region of Saudi Arabia, its clinical presentation, the diagnosis and the assessment of the value of short-term chemotherapy.A prospective study of 64 consecutive patients with proven tuberclous lymphadenpathy were included in this study, using FNA and/ or lymph node excisional biopsy. Of the sixty-four patients included in the study, seventeen [26.6%] were males and 47 [73.4%] females. Their ages ranged from 18 to 96 years with a mean age of 40 years. The number of patients who presented with constitutional symptoms was 33 [51.6%].There was a preponderance of females; the female to male ratio was 2.7%, consistent with other studies. Matting and fixation of the nodes to the surrounding structures was present in 24 [37.5%] patients, while the nodes were discrete in the rest. Among which discharging sinuses and abscesses were noted in 10.9% and 7.8% of the cases respectively. Conclusions: The diagnostic yield of FNA can be augmented by performing two FNA attempts. One to be sent for cytopathological examination and the other for AFB smear examination and Mycobacterial culture. A short course of combined chemotherapy consisting of rifampicin [600 mg orally once daily], INH [10mg/kg daily] and pyrazinamide [15 mg/ kg] for 6 months and ethambutol [15mg/kg] for 2 months was an effective and satisfactory therapy in our patients, as proven by the lack of recurrence or relapse after 5 years of follows up