Cervical Node Tuberculosis Research Articles

The value of histopathologic examination and Xpert (MTB/RIF) assay in diagnosis of cervical lymph node tuberculosis after coarse needle biopsy guided by CEUS: a retrospective analysis of 612 cases

ObjectiveTo investigate the value of histopathological examination (HPE) and Xpert Mycobacterium tuberculosis bacilli/rifampicin (MTB/RIF) assay in diagnosis of cervical lymph node tuberculosis (LN TB) after coarse needle biopsy (CNB).MethodsWe retrospectively analyzed 612 samples obtained from October 2017 to August 2023 from patients suspected cervical LN TB with surgically pathological, microbial culture confirmed, and clinically confirmed cervical lymph node enlargement who received ultrasound-guided CNB assisted by contrast-enhanced ultrasound (CEUS) at our hospital. All specimens were assessed by HPE and the Xpert (MTB/RIF) assay. We analyzed the results to determine the diagnostic value of HPE and Xpert (MTB/RIF) assay in samples taken after CEUS-assisted CNB of LN TB, and to evaluate the safety of CNB.ResultsBased on the comprehensive reference standard established in this study, 532 of 612 patients were diagnosed with cervical LN TB, of which 476 were CNB positive cases, the positive rate of diagnosis was 89.5%。The sensitivity, specificity, positive predictive value, negative and predictive value of HPE were 80.4%, 91.2%, 98.4%, 41.2% respectively, while those of the Xpert MTB/RIF assay were 75.7%, 98.7%, 99.7%, 38.0% respectively. No postoperative complications were noted, and the Clavien–Dindo grade was 2.ConclusionCEUS-assisted CNB has high diagnostic value and is safe for cervical LN TB. The sensitivity of HPE is slightly higher than that of Xpert (MTB/RIF) assay, and the specificity of Xpert (MTB/RIF) assay is higher than that of HPE, so Xpert (MTB/RIF) assay can correct the cervical lymph node tuberculosis with negative HPE.

Exploring the diagnostic value of ultrasound-guided lymph node fine-needle aspiration biopsy in the diagnosis of cervical lymph node tuberculosis: a medical discussion.

Exploring the diagnostic value of ultrasound-guided lymph node fine-needle aspiration biopsy in the diagnosis of cervical lymph node tuberculosis: a medical discussion.

Acute generalized exanthematous pustulosis induced by isoniazid and pyrazinamide in a child

An 8-year-old female with cervical lymph node tuberculosis, received rifampicin, isoniazid, pyrazinamide, and ethambutol. Two weeks later, she developed a fever and a generalized erythematous rash covered with pustules. Acute generalized exanthematous pustulosis diagnosis was confirmed by a skin biopsy. Antitubercular therapy was discontinued. Drug causality was found using oral provocation tests and patch tests. Cutaneous adverse drug reactions to first-line antituberculosis drugs are common. However, acute generalized exanthematous pustulosis is rare. It is a severe form of cutaneous drug reaction, primarily associated with beta-lactam antibiotics, and clinically characterized by non-follicular pustules on erythematous skin.

The Role of Surgery in the Treatment of Cervical Lymph Node Tuberculosis.

Cervical lymph node tuberculosis is a public health problem in Morocco and the rest of the world. Its paucibacillary nature makes diagnosis and treatment difficult. This is a descriptive-analytical retrospective study presenting 104 cases of patients with manifestations of cervical lymph node tuberculosis confirmed by pathological examination (100%), associated in some cases with positive bacteriology (40.6%), treated and followed up in the otolaryngology (ENT) department of the Cheikh Khalifa International University Hospital (HUICK) over a period of 5 years and 9 months (from January 01, 2017, to September 30, 2022). In our study, 14 patients (i.e., 13.5%) had a history of tuberculosis (all locations); only four (i.e., 3.8%) of them had confirmed cervical lymph node tuberculosis, of which three were still under treatment: two of them presented for treatment failure (i.e., 1.9%) and one patient for a paradoxical reaction (i.e., 1%). Three pulmonary locations (i.e., 2.9%) and one mediastinal location (i.e., 1%) were found. Surgery associated with histological study was the key to the diagnosis of tuberculosis in our study. Its procedures were: excisional biopsy for 26 patients (i.e., 25%), adenectomy for 54 patients (i.e., 51.9%), lymph node dissection for 15 patients (i.e., 14.4%), and lymphadenectomy for nine patients (i.e., 8.7%). In some cases, drainage (+/- curettage) was recommended in addition to the surgical procedure in 14 patients (i.e., 13.5%). All our patients benefited from post-surgical anti-bacillary treatment. Lymphorrhea was the only operative complication and it affected two patients (i.e., 1.9%). Meanwhile, the relapse rate was 10.6% (i.e., 11 patients), the treatment failure rate was 3.8% (i.e., four patients), and the paradoxical reaction affected 2.9% (i.e., three patients). The latter had all benefited from a simple biopsy. This indicates that a more extensive surgical procedure gives better results with a better healing rate. In conclusion, anti-bacillary treatment remains the reference treatment for lymph node tuberculosis. However, surgery holds great promise as the first-line treatment in case of fistula or abscess or in the event of failure or if complications occur.

Scrofula: a descriptive study on the clinical and diagnostic profile of patients with tuberculous lymphadenitis

Background: Tuberculosis remains to be the major health burden primarily affecting the developing countries. The commonest is pulmonary tuberculosis. The aim of the study was to study about the clinical presentation of tuberculous cervical lymphadenopathy and to correlate clinical diagnosis with the histopathological findings, management, outcome, follow up and improvement. Methods: A retrospective descriptive study involving 75 patients with cervical lymph node tuberculosis were followed up from the time of diagnosis till the completion of treatment. Results: It is more common in young females (21-30 years). Constitutional symptoms absent in most of the patients. Mantoux and erythrocyte sedimentation rate (ESR) raised in most cases. Fine needle aspiration cytology (FNAC) showed granuloma in 90.6% cases. GeneXpert results showed Mycobacterium tuberculosis (MTB) detected rifampicin (Rif) resistance not detected in 65.3% and MTB detected Rif resistance detected in 6.1%. Most of the patients recovered daily chemotherapy regimen. Surgery was rarely needed. Conclusions: TB is still the commonest cause of cervical lymph node enlargement in developing countries. FNAC is a rapid, cheap, simple, and effective method of diagnosis for cervical lymphadenopathy. Anti-tubercular drugs should be started in patients with FNAC/biopsy showing granuloma even if GeneXpert negative and all the patients must be followed up regularly.

Is nucleic acid amplification test sufficient enough for reducing the diagnostic dilemma of cervical lymph node tuberculosis? A descriptive study in a tertiary care hospital

Background: Pulmonary tuberculosis (TB) is common clinical presentation in India, but, nowadays, extrapulmonary TB (EPTB) is also a clinical problem. At present, no single test is available for diagnosing EPTB which is rapid, cost-effective, and confirmatory. Many studies were done to diagnose and treat the pulmonary TB, though more efforts are needed for diagnosis of EPTB. Aims and Objectives: The aim of this study is to find out any test or a series of tests that reduce the diagnostic dilemma of cervical lymph node TB. Materials and Methods: A total of 170 patients with cervical lymphadenopathy were enrolled in the pathology department between July 1, 2021, and December 31, 2021. It was a descriptive study and of cross-sectional design. The Institutional Ethics Committee approval was received (No. BSMC/IEC/101 dt. January 15, 2021). Suspected malignancy cases were excluded from the study. Fine-needle aspiration (FNA) was done for all these patients and stained with Leishman-Geimsa, Papaniculaou, and Zeihl-Neelsen (ZN) stain. After FNA, all samples were sent for cartridge based nucleic acid amplification test. Results: After FNA cytology, ZN stain was done and only 9.2% of acid–fast bacilli (AFB) positive cases were found. Granuloma was found in 27.6% of cases. After nucleic acid amplification test (NAAT) study, it was found that 36.8% patients were positive. Total number of lymph node considered to be positive for TB (NAAT positive and/or ZN stain positive and/or presence of granuloma) is 85 (52.1%). As per conventional method for diagnosis of lymph node TB (presence of granuloma and/or AFB positive in ZN stain), number of cases were 50 (30.7%). NAAT test was significantly more positive in respect of ZN staining but not significantly positive in respect of presence of granuloma. Conclusion: For diagnosis of cervical lymph node TB, all three methods (NAAT, ZN stain, and Leishman-Giemsa stain) should be used simultaneously.

Role of GeneXpert MTB/RIF assay for the diagnosis of cervical lymph node tuberculosis and rifampicin resistance.

Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.

A rare presentation of extra pulmonary tuberculosis in neck (isolated level-VI cervical lymph node tuberculosis)

<p class="abstract">One of the most common varieties of extra pulmonary tuberculosis is tuberculosis lymphadenitis. This was the case report of a 40-year-old female who presented with complaint of neck swelling and voice change and was later diagnosed with an isolated extra-pulmonary level-VI cervical lymph node tuberculosis. The diagnosis was made by histopathology and PCR and patient was then started with anti-tuberculosis therapy.</p>

Ultrasound-Based Radiomics Can Classify the Etiology of Cervical Lymphadenopathy: A Multi-Center Retrospective Study.

Medical diagnostic imaging is essential for the differential diagnosis of cervical lymphadenopathy. Here we develop an ultrasound radiomics method for accurately differentiating cervical lymph node tuberculosis (LNTB), cervical lymphoma, reactive lymph node hyperplasia, and metastatic lymph nodes especially in the multi-operator, cross-machine, multicenter context. The inter-observer and intra-observer consistency of radiomics parameters from the region of interest were 0.8245 and 0.9228, respectively. The radiomics model showed good and repeatable diagnostic performance for multiple classification diagnosis of cervical lymphadenopathy, especially in LNTB (area under the curve, AUC: 0.673, 0.662, and 0.626) and cervical lymphoma (AUC: 0.623, 0.644, and 0.602) in the whole set, training set, and test set, respectively. However, the diagnostic performance of lymphadenopathy among skilled radiologists was varied (Kappa coefficient: 0.108, *p < 0.001). The diagnostic performance of radiomics is comparable and more reproducible compared with those of skilled radiologists. Our study offers a more comprehensive method for differentiating LNTB, cervical lymphoma, reactive lymph node hyperplasia, and metastatic LN.

Evaluating the efficacy of stool sample on Xpert MTB/RIF Ultra and its comparison with other sample types by meta-analysis for TB diagnostics.

Precise and timely detection of tuberculosis (TB) is crucial to reduce transmission. This study aims to assess the accuracy of Xpert MTB/RIF Ultra on stool samples and systematically review the performance of Xpert MTB/RIF Ultra with different sample types by meta-analysis. Stool samples of smear-negative pulmonary TB (PTB), cervical lymph node TB, and abdominal TB patients were tested on the Xpert MTB/RIF Ultra system. Meta-analysis was performed on a set of 44 studies. Data were grouped by sample type, and the pooled sensitivity and specificity of Xpert MTB/RIF Ultra were calculated. The sensitivity of Xpert MTB/RIF Ultra with stool samples was 100% for smear-negative PTB, 27.27% for cervical lymph node TB, and 50% for abdominal TB patients, with 100% specificity for all included TB groups. The summary estimate for all PTB samples showed 84.2% sensitivity and 94.5% specificity, and EPTB samples showed 88.6% sensitivity and 96.4% specificity. Among all sample types included in our meta-analysis, urine showed the best performance for EPTB diagnosis. This pilot study supports the use of stool as an alternative non-invasive sample on Xpert MTB/RIF Ultra for rapid testing, suitable for both PTB and EPTB diagnosis.

A Case of Lung Cancer with Cervical Lymph Node Tuberculosis

A Case of Lung Cancer with Cervical Lymph Node Tuberculosis

Spectrum of anti tubercular therapy induced cutaneous adverse drug reactions and its management through rechallenge: A prospective study at a Tertiary Care Centre

IntroductionThe use of multi-drug regimens including 1st and 2nd line anti tubercular drugs in management of tuberculosis (TB) has been associated with undesirable adverse drug reactions including cutaneous one. Re-challenge remains the only option to restart the safe therapy and combat the tuberculous infection simultaneously. Materials and methodologyThis cross-sectional study was conducted via prospective review of outpatients as well as indoor patients who presented with cutaneous adverse drug reactions to ATT between March 2020 and March 2021. Data were analysed regarding demographic profile, site of TB, ATT regimen, pattern of cutaneous lesions, offending drugs, past history of drug allergy, and reinstitution of ATT after re-challenge. ResultsOut of total 56 registered tubercular patients presented with cutaneous adverse drug reaction 30 were females (53.57%). The most common site of TB was pulmonary followed by cervical lymph node TB. The three most common adverse drug reaction detected were maculopapular rash 32 (57.1%) followed by lichenoid drug eruptions in 6 (10.7%) and urticaria in 2 (3.6%). Ethambutol was found to be common offending drug followed by other first line anti-tubercular drugs. 5 patients developed multiple drug hypersensitivity on re-challenging and have to introduce steroids along with ATT. ConclusionAdverse cutaneous drug reactions to ATT is like a double-edged sword as stopping ATT and starting treatment with systemic steroids can further flare up the infection with increased risk of disseminated and multidrug resistant tuberculosis. Re-challenge was found out to be safest way in identifying culprit drug and hence to restart a safer alternate ATT regimen for better management.

Clinical analysis of lateral cervical approach in the treatment of cervical lymphatic tuberculosis complicated with parapharyngeal space abscess

Objective:To investigate the clinical effect of lateral cervical approach in the treatment of cervical lymphatic tuberculosis complicated with parapharyngeal space abscess. Methods:A total of 10 patients with cervical lymph node tuberculosis complicated with tuberculous abscess in parapharyngeal space were treated. Surgery was performed using a transcervical approach. The operation time and blood loss were recorded. The level of ESR, C-reactive protein（CRP）, VAS score and the rating of Kubota drinking test before and 2 weeks after operation were compared. The incision healing, symptoms of tuberculosis poisoning, and the CT findings of the cervical lesions were compared before operation, 2 weeks after operation and at the last follow-up. Results:The operation time ranged from 65 to 130 min with an average of （99.00±21.45） min. The intraoperative blood loss ranged from 100 to 250 mL with an average of （155.00±43.78） mL. The average pre-and post-operative level of ESR was （67.60±21.94） mm/1h and （30.30±13.76） mm/1h, respectively（U=5.500, P<0.01）; The average pre-and post-operative level of CRP was （69.70±31.13） mg/L and （42.40±19.70） mg/L, respectively（U=22.500, P<0.05）; The average pre-and post-operative VAS score was （5.60±1.26） points and （2.50±1.27） points, respectively（U=4.500, P<0.01）. As for Kubota drinking test, the rating was between 1-2 two weeks postoperatively. After relieving the compression, there was no obvious choking and coughing in drinking water. During the follow-up period （range: 6-24 months）, the surgical wound healed completely, and the symptoms of systemic tuberculosis poisoning disappeared. No obvious residual cavity or effusion was found in the parapharyngeal space by CT examination, nor was any protruding tissue in oropharynx. The edema of soft tissue surrounding the operational area disappeared, and the enlarged lymph nodes were significantly reduced. No sign of liquefaction, necrosis, suppuration or recurrence was observed. Conclusion:Surgery using transcervical approach effective in treating cervical lymph node tuberculosis with parapharyngeal space abscess.

DRESS syndrome aux antituberculeux : un véritable défi au praticien

Drug hypersensitivity syndrome (DRESS syndrome) is severe toxidermia with a high mortality estimated to be 10%. Antituberculosis drugs are rarely incriminated. We report through the observation of a 30years old female patient, who presented a DRESS syndrome inducted by antituberculosis drugs. She has cervical lymph node tuberculosis. The dermatological lesions were appeared 10days after the start of the antituberculosis drugs. The diagnosis of DRESS syndrome was retained over the presence of 4 criteria of the regiSCAR. The treatment was interrupted on admission and we started oral corticosteroids. With progressive clinico-biological improvement. Re-introduction of antituberculosis drugs was necessary and it was done with caution, which allows retaining the imputability of ethambutol. DRESS syndrome to antituberculosis drugs is rare; its management is not codified, requiring multidisciplinary collaboration.

A Case of Nasopharyngeal Tuberculosis with Cervical Lymph Node Tuberculosis Suspected of Cervical Malignant Disease at the First Examination.

A case of nasopharyngeal tuberculosis with cervical lymph node tuberculosis is reported. The patient was a 20-year-old female immigrant from Vietnam and cook apprentice. Her chief complaint was left neck swelling with pain for three months. She was diagnosed with left neck lymphadenitis at a previous hospital, which suspected malignant lymphoma and referred her to our hospital. At the time of the first visit, she had left lymph swelling with tenderness and granuloma-like masses in the nasopharynx. PET-CT showed accumulations in both the swollen left neck lymph and nasopharynx. The diagnosis of this case would appear to be nasopharyngeal cancer with left and neck lymph node metastasis or nasopharyngeal tuberculosis with cervical lymph node tuberculosis in addition to malignant lymphoma. Based on some examinations (biopsy, bacteria culture, and imaging), it was diagnosed as nasopharyngeal tuberculosis with cervical lymph node tuberculosis. Therefore, she was treated with anti-tuberculosis agent in respiratory medicine.

Effect of Ultrasound Images Based on Filtering Algorithm on the Diagnosis Efficiency of Cervical Lymph Node Tuberculosis

Objective: This paper uses filtering algorithms to explore and analyze the characteristics of cervical tuberculous lymph nodes and metastatic lymph nodes in ultrasound sonograms. Methods: 160 lymph nodes of 105 patients who obtained pathological results were retrospectively analyzed in this paper, including 76 tuberculous lymph nodes and 84 metastatic lymph nodes. The following ultrasound findings of lymph nodes in the two groups were compared: L/S, border, lymphatic door, internal echo, calcification, necrosis and liquefaction, and their characteristics were analyzed. Results: Both calcifications and liquid echoless areas were present in both groups. The internal calcifications of metastatic lymph nodes were mostly micro-calcifications, which were clustered, and the tuberculous lymph nodes were mostly scattered coarse calcifications. The difference was statistically significant (P &lt; 0.01). The liquefaction area in metastatic lymph nodes was mostly eccentric and the area ratio was less than 50%. The liquefaction area in tuberculous lymph nodes was mostly in the center and the area ratio was more than 50%. The difference was statistically significant (P &lt; 0 01). Conclusion: Ultrasound imaging features such as the size and distribution of calcification, and the location and area ratio of liquefaction zone are helpful to distinguish tuberculous lymph nodes from metastatic lymph nodes.

Sternocleidomastoid tumor of infancy-Importance of cytopathological diagnosis and challenges.

Sternocleidomastoid tumor of infancy (SCMI) is a rare, benign self-limiting condition which occurs in the perinatal period. The goal of our study is to highlight clinicoradiological and cytopathological findings in these cases. A study was done at a tertiary level hospital, from January 2016 to December 2019. Thirteen cases were studied, out of which 11 were clinically suspected cases of SCMI tumor and two cases were clinically suspected as cervical lymph node tuberculosis which were finally diagnosed as SCMI on fine needle aspiration cytology (FNAC) evaluation. Drs. N. K., S. Z., S. S. K., and S. R. independently reviewed the original diagnosis. Clinical, ultrasonographical, and cytopathological features are highlighted along with follow-up of the cases. There were a total of 13 cases, out of which 11 cases were neonates and two cases were more than 1 month of age (2 months and 2.5 months). Male: female ratio was 10:3 and swelling was present more commonly on the right side of the neck. Ultrasonography predominantly showed non-cystic, bulky, and heterogenous echotexture of the sternocleidomastoid muscle. Smears were moderately cellular showing mainly singly scattered oval to spindle shaped fibroblasts along with degenerating and regenerating muscle fibers. FNAC along with adequate clinic-radiological correlation aids in early and reliable diagnosis and can help curtail complications.

Plasma interferon-γ-inducible protein 10 (IP-10) levels correlate with disease severity and paradoxical reactions in extrapulmonary tuberculosis.

BackgroundWith 1.5 million deaths worldwide in 2018, tuberculosis (TB) remains a major global public health problem. While pulmonary TB (PTB) is the most common manifestation, the proportion of extrapulmonary TB (EPTB) is increasing in low-burden countries. EPTB is a heterogeneous disease entity posing diagnostic and management challenges due to the lack of reliable biomarkers. In this study, we prospectively evaluated clinical data and treatment response which were correlated with different biomarkers.MethodsThe study was conducted at the University Hospital of Cologne. 20 patients with EPTB were enrolled. We analyzed plasma interferon-γ-inducible protein 10 (IP-10) levels in plasma by ELISA for up to 12 months of treatment. In addition, the QuantiFERON®-TB Gold Plus (QFT® Plus) test was performed during the course of treatment. Clinical data were assessed prospectively and correlated with QFT® Plus and IP-10 levels.ResultsPlasma IP-10 levels were found to be significantly increased (p < 0.001) in patients with extensive disease compared to patients with limited disease (cervical lymph node TB) or healthy controls. In patients with clinically confirmed paradoxical reaction (PR), a further increase of IP-10 was noted. IFN-γ measured by the QFT® Plus test did not decrease significantly during the course of treatment. Of note, in four EPTB patients (20%) without radiographic pulmonary involvement, sputum culture was positive for Mycobacterium tuberculosis.ConclusionOur data demonstrate that IP-10 may be a valuable biomarker for estimation of disease severity in EPTB and monitoring of the disease course in extensive forms. However, IP-10 may be less suitable for diagnosis and monitoring of EPTB patients with limited disease. The QFT® Plus test does not appear to be a suitable marker for therapy monitoring. Sputum should be examined in EPTB patients even in case of normal diagnostic imaging of the chest.Supplementary information is available for this paper at 10.1007/s15010-020-01541-1.

Treatment of cervical lymph node tuberculosis: When surgery should be performed? A retrospective cohort study

Backgroundlymph node tuberculosis is the most common form of extra pulmonary tuberculosis. Although diagnosis is usually difficult, therapeutic management remains a challenge and a subject of national and international debate. Materials and methodsthe medical records of patients with cervical lymph node tuberculosis who were treated at 20 August Hospital, Casablanca, Morocco, between May 2017 and November 2018 were reviewed. The results of the treatment were analyzed retrospectively.The aim of our work was to identify all causes of medical treatment failure in cervical lymph node tuberculosis, and to propose indications for the use of surgery in cervical lymph node tuberculosis in Morocco. ResultsOut of a total of 104 patients, the mean age was 24 years, the sex ratio was 0.51 (women: 66.3%), twenty (19.2%) patients received medical treatment alone, and 84 (80.8%) patients required medical and surgical treatment. Surgery was required when the size of the lymphadenopathies was greater than or equal to 3 cm (p = 0.005), when the patient presented with an abscess and/or fistula(p = 0.005), when the patient presented with resistance to antibacillary drugs(p = 0.032), or developed a paradoxical upgrading reactions (p = 0.001), or when the patient had a recurrence of lymph node tuberculosis(p = 0.008) on multivariate analysis. Conclusionantibiotic therapy remains the main treatment for all patients in lymph node tuberculosis, but the results of our work show the value of surgery in some indications.

Quantitative determination of characteristic components from compound of Lysionotus pauciflorus Maxim. by LC–MS/MS and its application to a pharmacokinetic study

Tuberculosis of cervical lymph nodes is called scrofula in Traditional Chinese Medicine (TCM). Clinical manifestation is that unilateral or bilateral neck can have multiple enlarged lymph nodes of different sizes. Current therapeutic drugs include Lysionotus pauciflorus Maxim. tablets and compound of Lysionotus pauciflorus Maxim., which have a significant effect on tuberculosis of cervical lymph nodes. This compound is composed of three herbs, Lysionotus pauciflorus Maxim., Prunella vulgaris L. and Artemisia argyi Levl.et Vant. A selective and sensitive LC–MS/MS method was established and validated in rat plasma for the first time. Chromatographic separation was achieved on a Wonda Cract ODS-2 C18 Column (150 mm × 4.6 mm, 5 μm). The mobile phase contained 0.1% formic acid aqueous solution and acetonitrile with a flow rate of 0.8 mL/min. The detection was performed in negative electrospray ionization mode and the precursor/product ion transitions of six components and internal standard (IS) sulfamethoxazole were quantified in multiple reaction monitoring (MRM) using QTRAP-3200 MS/MS. The method fulfilled US Food and Drug Administration guidelines for selectivity, sensitivity, accuracy, precision, matrix effect, extraction recovery, dilution integrity, and stability. This proposed method was then successfully applied to a pharmacokinetic study after oral administration of 10 mL/kg compound extracts in rats. The pharmacokinetic parameters and plasma concentration-time profiles would prove valuable in pre-clinical and clinical investigations on the disposition of compound medicine.