Clinicopathological profile and outcome of 29 lymph node tuberculosis cases

Abstract

Introduction: In countries like Bangladesh, tuberculous lymphadenopathy is a common extrapulmonary site. Its diagnosis and management is a challenge for the primary care physicians for its various clinical and pathological presentations. Hence, the objective of the present study is to describe the clinicopathological profile and outcome of lymph node tuberculosis (TB) cases in our setting. Methods: It was a prospective observational study done among 29 lymph node cases attending the outpatient and inpatient department of medicine of a tertiary care hospital in a period of 2 years. After written informed consent, clinical points are noted and fine-needle aspiration cytology (FNAC) or biopsy of lymph node was done and histologically evaluated and the patients were followed up further. After collection of all data, it was compiled and analyzed by SPSS version 20. Results: Among 29 cases, female patients (17, 58.6%) were more than the male (12, 41.4%) patients and most of the patients were at the age group of 21–30 years (48.3%). Most patients presented with fever (62.1%), weight loss (51.7%), night sweating 62.1%), anorexia (55.2%), and cough (27.6%). Among all, 20 (69%) patients presented with multiple enlarged lymph node group and 9 (31.0%) had involvement of single group. Cervical group involvement was the most common (25, 86.2%), and matting of lymph node was present in 20 (69%) cases. Among all, 24 (82.8%) cases were diagnosed by FNAC and 5 (17.2%) was diagnosed by biopsy. In microscopic evaluation, 18 (62.1%) cases had caseous necrosis, 27 (93.1%) had epithelioid cells and 8 (27.6%) had giant cells. Regarding other investigations, 8 (27.6%) patients had positive mantoux test (MT), 4 (13.8%) had concomitant pulmonary TB, and one case was found sputum positive for acid-fast bacilli. Regarding outcome evaluation, 20 (69%) cases were declared cured, 7 (24.1%) were lost to follow-up, one case died, and one cases was declared multi drug resistant tuberculosis (MDR) TB. Conclusion: In the study, bacteriological evaluation of the response to treatment cannot be done due to difficulty in obtaining follow-up specimens from the lymph node. Response was judged on the basis of clinical features and local examination findings.