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Cervical Lymphadenopathy—Pitfalls of Blind Antitubercular Treatment
Pandit, Sudipta; Choudhury, Sabyasachi; Das, Anirban; Das, Sibes Kumar & Bhattacharya, Soumya
Abstract
Tuberculosis (TB) is the most common cause of cervical lymphadenopathy in the TB-endemic zone, like
India but it can also mimic other diseases. Four cases of cervical lymphadenopathy presented to us as initial
treatment failure after completion of six months of antitubercular drugs (ATD), including rifampicin,
isoniazid, pyrazinamide, and ethambutol. All were diagnosed as having tuberculosis either by fine needle
aspiration cytology or clinically from outside our institution. In one case, tuberculosis was the final diagnosis
but, unfortunately, it was multidrug-resistant. In other three cases, Hodgkin disease, Non-Hodgkin
lymphoma, and Kikuchi’s disease were the diagnoses. In resource-poor countries, like India, which is also
a TB-endemic zone, TB should be the first diagnosis in all cases of chronic cervical lymphadenopathy,
based on clinical and/or cytological evidences. So, they were correctly advised antitubercular therapy (ATT)
initially. Sometimes, TB mimics other aetiologies where apparent initial improvement with ATT finally
results in treatment failure. Hence, investigations for microbiological and histopathological diagnosis are
warranted, depending on the resources and feasibility. If these tests are not routinely available, the patients
should be under close monitoring so that lymphoma, drug-resistant TB, or other aetiologies of cervical
lymphadenopathy are not missed. Patients with cervical lymphadenopathy rarely presents acutely; so, a
physician can take the opportunity of histopathological study of lymphnode tissue.
Keywords
Cervical lymphadenopathy; Excision biopsy; Hodgkin disease; Kikuchi’s disease; Non-Hodgkin lymphoma; Tuberculosis
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