View source for Tuberculous lymphadenitis

==Background==
*Also known as "scrofula" when involves cervical lymph nodes 
*Most common form of extrapulmonary [[TB]]
*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>
*In the US, more common among Asian Pacific Islanders and in females
*Most cases occur in the setting of reactivation of latent infection

==Clinical Features==
[[File:Tubercular adinitis with sinus.jpg|thumb|Tubercular adenitis with sinus.]]
[[File:PMC4555907 IJSTD-36-80-g001.png|thumb|Matted lymph nodes in the right inguinal region. Discharging sinus and healed scars on the left side.]]
*Enlarging, painless, red, firm, [[neck mass|mass]], most commonly in the anterior or posterior cervical chain
*Can be complicated by ulceration, fistula, or [[abscess]] formation
*Systemic signs and symptoms are uncommon, except patients with [[HIV]] (in whom lymphadenitis is usually generalized)

==Differential Diagnosis==
{{Lymphadenitis DDX}}
{{Neck mass DDX}}

==Evaluation==
*Fine needle aspiration: sensitivity and specificity (77 and 93% respectively)<ref>Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.</ref>
*Excisional biopsy (if FNA is not diagnostic)
**highest diagnostic yield 
**Submit specimens for histology, culture, and Nucleic acid amplification testing
**caseating granulomas on histopathology is highly suggestive of TB
*CT can be useful to identify involved lymph nodes for biopsy
*CXR: most do not have evidence of active pulmonary TB in nonendemic countries
*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref>

==Management==
*Medical therapy
**[[Rifampicin]], [[isoniazid]], [[ethambutol]], and [[pyrazinamide]] (RIPE therapy) given daily x 2 months
**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months
*Surgical excision may be performed if medical therapy fails
*Do not I&D, can result in permanent sinuses and prolonged drainage

==Disposition==

==See Also==
*[[Lymphadenitis]]
*[[TB]]

==External Links==

==References==
<references/>

[[Category:ID]] [[Category:Dermatology]]