A DISTINCTIVE CYTOLOGIC PATTERN FOR DIAGNOSING TUBERCULOUS LYMPHADENITIS IN AIDS

Tuberculous lymphadenitis (TL) is a very common infection in human imm unodeficiency virus (HIV)-infected patients. We performed fine-needle aspiration biopsy (FNAB) of enlarged lymph nodes in 57 HIV-infected pa tients to evaluate its usefulness in this population. We observed thre e cytologic patterns in 21 patients diagnosed as having TL: granulomat ous lymphadenitis (GL) in 4 FNABs, necrotizing granulomatous lymphaden itis (NGL) in 7 FNABs, and necrotizing lymphadenitis (NL) in 12 FNABs. GL and NGL are already well-known and considered to be highly suggest ive of TL. Our results support the idea that NL should have the same d iagnostic value as GL or NGL. In the group of 12 patients with NL, TL was confirmed in 11 by microbiologic methods (7 by a positive Ziehl-Ne elsen stain and 4 by a positive Lowenstein culture) and in the remaini ng patient by a biopsy that showed NGL with acid-fast bacilli. We conc lude that FNAB is a useful, inexpensive, and safe technique for diagno sing TL in HIV-infected patients. The finding of a NL pattern is sugge stive enough of TL to start antituberculous treatment.