Tuberculous Lymphadenitis in Southern Italy: Clinical Aspects and Treatment Perspectives

Lymph node tuberculosis (TB) represents the most common form of extrapulmonary TB that affects most often laterocervical lymph nodes. The disease, favored by states of immunosuppression, manifests itself by usually unilateral swelling, which may be associated with skin changes (hyperaemia, infiltration or fistula) and poor systemic symptoms. Our study included 75 patients arrived at the hospital “V. Monaldi” of Naples from 2008 to 2012, in order to evaluate some aspects of clinical, diagnostic and therapeutic characteristics of tuberculous lymphadenopathy. All patients were subjected to clinical, microbiological and radiological findings, surgical biopsy (alternatively, fine needle aspiration cytology, FNAC) of lymph nodes affected by pathology, antituberculosis chemotherapy for six months and subsequent followup. 49% patients were female and 51% male (mean age 44.5 years). 50.7% of patients were immunocompromised (6.7% of HIV-positive cases, 4% with type II diabetes mellitus, 16% of drug users, 6.7% treated with immunosuppressive drugs, 4% affected by malnutrition, 12% homeless). The laterocervical lymphadenopathy was unilateral in 70.7% of cases, smaller than 2 cm in 66.7%, single in 62.7%, with normal overlying skin in 72%. 9.3% of cases showed pulmonary involvement. 68% of cases excisional biopsy was performed for microbiological and histopathological examination and in 32% patients FNAC (integrated with excisional biopsy in more than half of the cases). Lymph node tuberculosis is still a problem of high clinical significance. Diagnosis requires excisional biopsy for differential diagnosis from other forms of adenopathy; treatment utilises a multi-agent chemotherapy scheme that allows a good cure rate, with few side effects.