Clinical analysis of 21 cases of cervical tuberculous lymphadenitis without active pulmonary lesion

Abstract

Conclusion: The necessity of considering cervical tuberculous lymphadenitis (CTL) should be emphasized even today for the differential diagnosis of cervical lymphadenopathy, particularly when it is located in the posterior triangle and supraclavicular regions even in patients without active pulmonary tuberculosis (PTB). Objective: This study was conducted to highlight the characteristics of patients with CTL without active PTB who were treated in our department. Methods: Between 2004 and 2011, 21 cases of CTL without active PTB were included in this retrospective study. Histological examination after excisional biopsy of the affected lymph node was performed in 18 patients using hematoxylin and eosin staining and Ziehl-Neelsen (Z-N) staining for acid-fast bacilli (AFB) identification. Growth of Mycobacterium tuberculosis was detected by culturing and/or nucleic acid amplification tests including polymerase chain reaction (PCR) and transcription-mediated amplification (Mycobacterium Tuberculosis Direct: MTD). Results: The male to female ratio was 1:1.3. Patient ages ranged from 22 to 89 years. Eighteen patients (85.7%) complained of indolent unilateral cervical lymphadenopathy in the posterior triangle (26.5%), internal jugular (24.5%), or supraclavicular nodes (18.4%). Positive rates of AFB according to Z-N staining and culturing of M. tuberculosis and/or PCR or MTD were 33.3% (6/18) and 72.2% (13/18), respectively.

Keywords::

• Head and neck
• tuberculosis
• lymphadenopathy
• posterior triangle
• tuberculin skin test
• QuantiFERON test
• computed tomography
• chemotherapy

Acknowledgment

The authors wish to thank Professor Kenichi Wakasa at the Department of Diagnostic Pathology of Osaka City University Hospital for histopathological diagnosis of each case.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.