Tuberculous lymphadenitis - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2020-09-09T21:42:03Z

Differential Diagnosis

← Older revision		Revision as of 21:42, 9 September 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Lymphoma]]		{{Lymphadenitis DDX}}
	*Metastatic cancer
	*[[Fungal infection]]
	*[[Cat-scratch disease]]
	*[[Sarcoidosis]]
	*[[Toxoplasmosis]]
	*Reactive adenitis
	*Bacterial [[lymphadenitis]]

	{{Neck mass DDX}}		{{Neck mass DDX}}

Rossdonaldson1: /* Clinical Features */

2020-09-08T21:09:54Z

Clinical Features

← Older revision		Revision as of 21:09, 8 September 2020
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	==Clinical Features==		==Clinical Features==
	[[File:Tubercular adinitis with sinus.jpg\|thumb\|Tubercular adenitis with sinus.]]		[[File:Tubercular adinitis with sinus.jpg\|thumb\|Tubercular adenitis with sinus.]]
			[[File:PMC4555907 IJSTD-36-80-g001.png\|thumb\|Matted lymph nodes in the right inguinal region. Discharging sinus and healed scars on the left side.]]
	*Enlarging, painless, red, firm, [[neck mass\|mass]], most commonly in the anterior or posterior cervical chain		*Enlarging, painless, red, firm, [[neck mass\|mass]], most commonly in the anterior or posterior cervical chain
	*Can be complicated by ulceration, fistula, or [[abscess]] formation		*Can be complicated by ulceration, fistula, or [[abscess]] formation

Rossdonaldson1: /* Clinical Features */

2020-09-08T21:06:48Z

Clinical Features

← Older revision		Revision as of 21:06, 8 September 2020
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	==Clinical Features==		==Clinical Features==
			[[File:Tubercular adinitis with sinus.jpg\|thumb\|Tubercular adenitis with sinus.]]
	*Enlarging, painless, red, firm, [[neck mass\|mass]], most commonly in the anterior or posterior cervical chain		*Enlarging, painless, red, firm, [[neck mass\|mass]], most commonly in the anterior or posterior cervical chain
	*Can be complicated by ulceration, fistula, or [[abscess]] formation		*Can be complicated by ulceration, fistula, or [[abscess]] formation

ClaireLewis: /* Differential Diagnosis */

2019-09-28T01:59:38Z

Differential Diagnosis

← Older revision		Revision as of 01:59, 28 September 2019
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	*[[Lymphoma]]		*[[Lymphoma]]
	*Metastatic cancer		*Metastatic cancer
	*Fungal ~~disease~~		*[[Fungal infection]]
	*[[Cat-scratch disease]]		*[[Cat-scratch disease]]
	*[[Sarcoidosis]]		*[[Sarcoidosis]]
	*[[Toxoplasmosis]]		*[[Toxoplasmosis]]
	*Reactive adenitis		*Reactive adenitis
	*Bacterial ~~adenitis~~		*Bacterial [[lymphadenitis]]

	{{Neck mass DDX}}		{{Neck mass DDX}}

Neil.m.young: Text replacement - " percent" to "%"

2017-11-10T07:01:57Z

Text replacement - " percent" to "%"

← Older revision		Revision as of 07:01, 10 November 2017
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	==Evaluation==		==Evaluation==
	*Fine needle aspiration: sensitivity and specificity (77 and 93 ~~percent~~ respectively)<ref>Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.</ref>		*Fine needle aspiration: sensitivity and specificity (77 and 93% respectively)<ref>Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.</ref>
	*Excisional biopsy (if FNA is not diagnostic)		*Excisional biopsy (if FNA is not diagnostic)
	**highest diagnostic yield		**highest diagnostic yield

Mholtz: Text replacement - "* " to "*"

2017-07-24T01:13:11Z

Text replacement - "* " to "*"

← Older revision		Revision as of 01:13, 24 July 2017
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	**Submit specimens for histology, culture, and Nucleic acid amplification testing		**Submit specimens for histology, culture, and Nucleic acid amplification testing
	**caseating granulomas on histopathology is highly suggestive of TB		**caseating granulomas on histopathology is highly suggestive of TB
	* CT can be useful to identify involved lymph nodes for biopsy		*CT can be useful to identify involved lymph nodes for biopsy
	*CXR: most do not have evidence of active pulmonary TB in nonendemic countries		*CXR: most do not have evidence of active pulmonary TB in nonendemic countries
	*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref>		*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref>

	==Management==		==Management==
	* Medical therapy		*Medical therapy
	**[[Rifampicin]], [[isoniazid]], [[ethambutol]], and [[pyrazinamide]] (RIPE therapy) given daily x 2 months		**[[Rifampicin]], [[isoniazid]], [[ethambutol]], and [[pyrazinamide]] (RIPE therapy) given daily x 2 months
	**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months		**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months
	* Surgical excision may be performed if medical therapy fails		*Surgical excision may be performed if medical therapy fails
	*Do not I&D, can result in permanent sinuses and prolonged drainage		*Do not I&D, can result in permanent sinuses and prolonged drainage

ClaireLewis at 16:27, 17 May 2017

2017-05-17T16:27:15Z

← Older revision		Revision as of 16:27, 17 May 2017
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	<references/>		<references/>

	[[Category:ID]]		[[Category:ID]] [[Category:Dermatology]]
	[[Category:Dermatology']]

ClaireLewis at 16:21, 17 May 2017

2017-05-17T16:21:42Z

← Older revision		Revision as of 16:21, 17 May 2017
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	==Background==		==Background==
	*Also known as scrofula		*Also known as "scrofula" when involves cervical lymph nodes
	*Most common form of extrapulmonary [[TB]]		*Most common form of extrapulmonary [[TB]]
	*Tuberculous lymphadenitis in the cervical region is known as scrofula
	*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>		*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>
			*In the US, more common among Asian Pacific Islanders and in females
	*Most cases occur in the setting of reactivation of latent infection		*Most cases occur in the setting of reactivation of latent infection
	*In the US, more common among Asian Pacific Islanders and in females

	==Clinical Features==		==Clinical Features==
	*Enlarging, painless, red, firm, mass, most commonly in the anterior or posterior cervical chain		*Enlarging, painless, red, firm, [[neck mass\|mass]], most commonly in the anterior or posterior cervical chain
	*Can be complicated by ulceration, fistula, or abscess formation		*Can be complicated by ulceration, fistula, or [[abscess]] formation
	*Systemic signs and symptoms are uncommon, except in HIV ~~patients~~ (in whom lymphadenitis is usually generalized)		*Systemic signs and symptoms are uncommon, except patients with [[HIV]] (in whom lymphadenitis is usually generalized)

	==Differential Diagnosis==		==Differential Diagnosis==
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	**caseating granulomas on histopathology is highly suggestive of TB		**caseating granulomas on histopathology is highly suggestive of TB
	* CT can be useful to identify involved lymph nodes for biopsy		* CT can be useful to identify involved lymph nodes for biopsy
	*CXR: most do not have evidence of active pulmonary TB in nonendemic ~~contries~~		*CXR: most do not have evidence of active pulmonary TB in nonendemic countries
	*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref>		*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref>

	==Management==		==Management==
	* Medical therapy		* Medical therapy
	**Rifampicin, isoniazid, ethambutol, and pyrazinamide (RIPE therapy) given daily x 2 months		**[[Rifampicin]], [[isoniazid]], [[ethambutol]], and [[pyrazinamide]] (RIPE therapy) given daily x 2 months
	**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months		**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months
	* Surgical excision may be performed if medical therapy fails		* Surgical excision may be performed if medical therapy fails

Rossdonaldson1: /* Differential Diagnosis */

2017-05-17T05:36:20Z

Differential Diagnosis

← Older revision		Revision as of 05:36, 17 May 2017
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	*Reactive adenitis		*Reactive adenitis
	*Bacterial adenitis		*Bacterial adenitis

			{{Neck mass DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2017-05-17T05:35:15Z

Background

← Older revision		Revision as of 05:35, 17 May 2017
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	==Background==		==Background==
			*Also known as scrofula
	*Most common form of extrapulmonary [[TB]]		*Most common form of extrapulmonary [[TB]]
	*Tuberculous lymphadenitis in the cervical region is known as scrofula		*Tuberculous lymphadenitis in the cervical region is known as scrofula
	*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>		*TB causes up to 43% of peripheral lymphadenopathy in the developing world <ref>Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.</ref>
	*Most cases occur in the setting of reactivation of latent infection		*Most cases occur in the setting of reactivation of latent infection
	*In the US, more common ~~amoung~~ Asian Pacific Islanders and in females		*In the US, more common among Asian Pacific Islanders and in females

	==Clinical Features==		==Clinical Features==