2024 Volume 117 Issue 8 Pages 767-772
In otorhinolaryngological practice, extrapulmonary tuberculosis with lesions in the cervical lymph nodes, pharynx, or middle ear is not uncommon, although it is sometimes difficult to diagnose. In this study, we examined the clinical features of cervical tuberculous lymphadenitis and the diagnostic approach.
We reviewed the data of 18 cases of cervical tuberculous lymphadenitis that were diagnosed at our department between 2011 and 2021.
The patients ranged in age from 22 to 87 years old (mean 47.3 years old). There were 10 men and 8 women; 10 were Japanese and 8 were foreign nationals. Fine needle aspiration cytology was performed in 13 cases, and the positivity rate for tuberculosis was 18.8% on cytology, 46.2% on the smear test for Mycobacterium tuberculosis, 46.2% on culture, and 76.9% on the PCR test. The positivity rate on any one of all the tests was 92.3% (12/13 cases), suggesting that the positivity rate increased when a combination of tests was used. Open biopsy was performed in the remaining 4 cases, and the diagnosis was confirmed in 3 of the 4 cases.
The remaining 3 cases were judged comprehensively by interferon-gamma release assays (IGRA) and other methods.
The most common subjects in this study were young foreign nationals from areas with a high prevalence of tuberculosis and elderly Japanese patients with underlying diseases such as diabetes mellitus or undergoing dialysis. There were cases in which tuberculosis was not suspected at the time of the initial examination, so that countermeasures to prevent exposure to tuberculosis were not taken during the examination. We consider that combined use of multiple testing methods on specimen obtained by fine needle aspiration increases the diagnosis rate and allows unnecessary open biopsy to be avoided.
When cervical lymphadenopathy is detected, it is important to keep the possibility of cervical tuberculous lymphadenitis in mind, and in high-risk cases, various tests should be performed to exclude tuberculosis.
