Diagnosis and treatment of cervical tuberculous lymphadenitis.

PURPOSE: This study presents the long-term results of treatment of a series of patients with tuberculous mycobacterial lymphadenitis of the head and neck.

PATIENTS: Twenty-one patients were seen in a 10-year period. The median age at onset was of 41.2 years (range, 4 to 79 years), and the male-to-female ratio was 11:10. Sixteen patients were of Ethiopian origin, 3 from the former USSR, and 2 were Israeli women (1 of Indian and 1 of Morrocan origin). Symptoms started between 2 weeks and 6 months before presentation (mean, 5.8 weeks). Most patients had negative chest radiographs, a variable response to the tuberculin skin test, and a negative culture for mycobacterial organisms.

RESULTS: Fine-needle aspiration (FNA) of the cervical lymph nodes was the most reliable method to confirm the bacteriologic agent causing the lymphadenopathy. Acid-fast bacilli smears of the aspirate were positive in all but 3 patients, whereas histologic examination of the lymph nodes gave diagnostic results in only two thirds of cases examined. All patients were treated with antituberculous chemotherapy. Sixteen patients also underwent surgical excision of their cervical lymph nodes, and all of them showed a complete response to the combined treatment. The remaining patients reacted to chemotherapy alone with complete cure. One patient died of gastric carcinoma, and the only acquired immune deficiency syndrome (AIDS) patient died a year later of cytomegalovirus encephalitis.

CONCLUSION: The most reliable indicator of cervical mycobacterial infection is an acid-fast smear from the FNA specimen. Antituberculous chemotherapy, with or without surgical excision of the involved cervical lymph nodes, is the method of choice for treatment of this disease.