Khalid Hussain Mahida, Sohail Akhtar.
Cervical tuberculous lymphadenitis: experience at tertiary care hospital.
Pak J Chest Med Jan ;21(1):10-4.

Background and Objectives: Among extra pulmonary tuberculosis, cervical lymph node involvement is very common. This prospective study was done to observe the clinical manifestation of the disease and histologic pattern and treatment involved and follow-up. Methods: Patients were enrolled from outpatient clinics of otolaryngology (ENT) and medicine departments of Ziauddin Hospital Kemari Campus with neck lumps. Lymphadenopathy secondary to acute ear nose throat and dental infections and cases with concurrent pulmonary tuberculosis were excluded. The cervical lymphadenopathy due to other causes like neck metastasis of primary head and neck neoplasia, and chronic inflammatory causes like sarcoidosis and kikuchi's disease were also excluded. Clinical work-up included history and detailed examination of ENT including fibrelaryngoscopy. Investigations included a complete blood picture, Erythrocyte sedimentation rate (ESR), Mantoux test, chest radiograph, and fine needle aspiration (FNA) cytology in all cases with excision biopsies in cases where FNA was inconclusive. Antituberculous therapy initiated and the cases were followed up for one year. Results: There were 46 cases (36 females) recruited from January 2010 to December 2013 out of a total sample of 68; mean age was 22 years. Most cases (74%) had fever at presentation while 96% had a raised ESR. Most (82%) had unilateral enlargement of lymph nodes, 80% of them being in the posterior triangle of neck. All the cases had normal chest radiograph. In 17 of the cases FNAC was diagnostic while in the rest of 29 cases diagnosis was made by histopathology of resected nodes. The antituberculous treatment was given for 6 months and the follow-up done for one year. Satisfactory results yielded in all cases with lessening in the sizes of lump and good symptomatic reliefs Conclusions: Tuberculosis was the most significant cause of neck lymphadenopathy in this cohort. Almost all cases can be diagnosed with histopathology although the yield of FNA in our series was lower. Most cases can be managed as easily and involvement of physicians trained in tuberculosis is useful.

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