Tuberculous lymphadenitis

Widespread tuberculosis of the lymph nodes is not uncommon in many areas. It usually involves the nodes of the neck, or less often those of the axilla, iliac region, or groin, mainly in children and young adults, although no age is exempt. All four triangles of neck may contain matted masses of glands. If these are not treated, abscesses may form and discharge through the skin, to leave sinuses which may become secondarily infected. After many months, these abscesses may heal spontaneously, to cause severe fibrosis and lymphatic obstruction in the leg (31.4), arm, breast (31.4), or vulva (20.14).

TUBERCULOUS LYMPHADENITIS. Biopsy a lymph node to confirm the diagnosis. You may find that tuberculous lymphadenitis is so common that you cannot biopsy every suspect node. But remember that biopsy is simple, and needs only local anaesthesia.

Give chemotherapy (29.1). Don't excise the enlarged nodes. Don't be alarmed if they enlarge temporarily during chemotherapy, or, rarely, after it, without microbiological relapse. This is due to hypersensitivity to tuberculoprotein. All nodes become smaller in time