ISOLATED PERIPHERAL TUBERCULOUS LYMPHADENITIS IN ADULTS - CURRENT CLINICAL AND DIAGNOSTIC ISSUES

Eight cases of isolated peripheral tuberculous lymphadenitis occurred over a 16-month period at our institution, prompting a literature revi ew to establish the epidemiology, clinical manifestations, and current approaches to diagnosis and treatment of this disorder. It occurs mos t commonly in young adult women who either are immigrants from areas w here tuberculous is endemic or have histories of travel that are sugge stive of exposure to Mycobacterium tuberculosis. The disease is indole nt and usually presents as a unilateral painless neck mass. Constituti onal symptoms are rare, except in individuals infected with the human immunodeficiency virus (HIV). The results of skin testing with purifie d protein derivative are invariably positive. Excisional biopsy for hi stopathologic and microbiological evaluations provides the highest dia gnostic yield, although fine needle aspiration may be useful for HIV-i nfected individuals and in areas of the world with a high prevalence o f disease. A 6-month course of combination antituberculous therapy is adequate for disease due to susceptible organisms. This infection may be readily diagnosed if suggestive epidemiological and clinical findin gs lead to expeditious tissue sampling.