Abstract
BackgroundThe therapeutic response of cervical tuberculous lymphadenitis (CTBL) may be delayed or paradoxical, with the frequent development of residual lymph nodes (LNs) during and after antituberculous treatment. We investigated the incidence of residual LNs and the clinical, radiological, microbiological, and pathologic responses of patients with CTBL after 6 months of antituberculous therapy.MethodsThe medical records of HIV-negative adult patients with CTBL diagnosed between July 2009 and December 2017 were analyzed. After 6 months of first-line antituberculous treatment, computed tomography (CT) scans were conducted to evaluate for residual LNs. Fine-needle aspiration biopsy (FNAB) was carried out if a patient presented with residual LNs > 10 mm in diameter with central necrosis, peripheral rim enhancement, or perinodal inflammation on CT scan.ResultsResidual LNs were detected in 35 of 157 patients who underwent follow-up CT scans and were more commonly observed in younger patients who completed the treatment (mean years ± standard deviation [SD]: 33 ± 13 vs. 44 ± 16, p < 0.001). The recurrence rate was approximately 5%, which was not significantly different in both groups. Among the 15 patients who underwent FNAB, 3 (30%) presented with granuloma, and 2 of 15 and 10 of 14 patients had positive AFB and TB PCR results, respectively. The TB culture results of 15 patients were negative.ConclusionsResidual LNs may still be observed after 6 months of antituberculous treatment. Although the radiologic and pathologic findings after treatment are still indicative of TB, not all residual LNs indicate recurrence or treatment failure. A six-month therapy may be sufficient for cervical tuberculous lymphadenitis.
Highlights
The therapeutic response of cervical tuberculous lymphadenitis (CTBL) may be delayed or paradoxical, with the frequent development of residual lymph nodes (LNs) during and after antituberculous treatment
Radiological, microbiological and pathologic characteristics of residual LNs after sixmonth of antituberculous therapy in human immunodeficiency virus (HIV)-negative individuals with CTBL
All patients with CTBL were diagnosed via fine-needle aspiration biopsy (FNAB); the patients with CTBL who presented with cervical LN involvement only after completing the firstline antituberculous treatment were re-assessed
Summary
The therapeutic response of cervical tuberculous lymphadenitis (CTBL) may be delayed or paradoxical, with the frequent development of residual lymph nodes (LNs) during and after antituberculous treatment. Seok et al BMC Infectious Diseases (2019) 19:867 based on studies showing no significant differences in treatment failure or complication [7,8,9]. Evidence supporting this recommendation for all cases of tuberculous lymphadenitis is limited because, unlike in pulmonary TB, there is no clear criteria for the assessment of extrapulmonary TB after treatment. The response to antituberculous treatment is delayed, and paradoxical reactions occur more frequently in individuals with extrapulmonary TB than in those with pulmonary TB. Additional treatment is recommended on the basis of microbiological testing results showing that LN is still found after short-term observation
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