Diagnosis and treatment of cervical tuberculous lymphadenitis

Purpose: This study presents the long-term results of treatment of a series of patients with tuberculous mycobacterial lymphadenitis of the head and n eck. Patients: Twenty-one patients were seen in a 10-year period. The median age at onset was of 41.2 years (range, 4 to 79 years), and the male-to-female ratio was 11:10. Sixteen patients were of Ethiopian origin, 3 from the form er USSR, and 2 were Israeli women (1 of Indian and 1 of Morrocan origin). S ymptoms started between 2 weeks and 6 months before presentation (mean, 5.8 weeks). Most patients had negative chest radiographs, a variable response to the tuberculin skin test, and a negative culture for mycobacterial organ isms. Results: Fine-needle aspiration (FNA) of the cervical lymph nodes was the m ost reliable method to confirm the bacteriologic agent causing the lymphade nopathy, Acid-fast bacilli smears of the aspirate were positive in all but 3 patients, whereas histologic examination of the lymph nodes gave diagnost ic results in only two thirds of cases examined. All patients were treated with antituberculous chemotherapy. Sixteen patients also underwent surgical excision of their cervical lymph nodes, and all of them showed a complete response to the combined treatment. The remaining patients reacted to chemo therapy alone with complete cure. One patient died of gastric carcinoma, an d the only acquired immune deficiency syndrome (AIDS) patient died a year l ater of cytomegalovirus encephalitis. Conclusion: The most reliable indicator of cervical mycobacterial infection is an acid-fast smear from the FNA specimen. Antituberculous chemotherapy, with or without surgical excision of the involved cervical lymph nodes, is the method of choice for treatment of this disease. (C) 2000 American Asso ciation of Oral and Maxillofacial Surgeons.