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Practice Lesson of the Week

Treatment for lymph node tuberculosis

BMJ 2010; 340 doi: (Published 10 March 2010) Cite this as: BMJ 2010;340:c63
  1. Rob S Sellar, registrar in haematology1,
  2. E L Corbett, reader in infectious and tropical diseases2,
  3. Shirley D’Sa, consultant haematologist13,
  4. David C Linch, professor of haematology and head of department14,
  5. Kirit M Ardeshna, consultant haematologist13
  1. 1University College London Hospitals, London NW1 2PG
  2. 2London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. 3Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN
  4. 4University College London, London WC1E 6BT
  1. Correspondence to: K M Ardeshna kirit.ardeshna{at}
  • Accepted 9 November 2009

Treatment for lymph node tuberculosis must be preceded by adequate pathological investigation of the lymphadenopathy

Among the numerous causes of lymphadenopathy, tuberculosis and lymphoma are both relatively common and potentially curable. The clinical features of tuberculous lymphadenitis overlap with those of lymphoma: some patients with each condition are asymptomatic apart from painless swelling, whereas others are unwell and have systemic symptoms such as fevers, weight loss, or night sweats. Accurate diagnosis depends on confirmation with appropriate pathology tests. We present three patients with lymphoma who were initially misdiagnosed as having tuberculosis. In each case this led to a delay in the treatment of the lymphoma, and in one case, chronic side effects from the unnecessary exposure to tuberculosis treatment compromised the treatment of the lymphoma. Lymph node biopsy and adequate histopathological assessment would have prevented these misdiagnoses and should be mandatory in suspected cases of lymph node tuberculosis when microscopy and cytology of fine needle aspirate does not show alcohol and acid fast bacilli, caseating granuloma, or granuloma with Langerhan’s cells.

Case 1

A 24 year old man was referred to a respiratory clinic with a four month history of lethargy, weight loss, and night sweats, together with a mass on the right side of his neck and a prominent right tonsil. More recently he had developed a cough and had had three episodes of green sputum. He was previously well and had no personal or family history of tuberculosis. He was born in the United Kingdom to Pakistani parents and received a BCG vaccination at school. He had visited Pakistan two years previously, and one year before presentation had come into contact with tuberculosis through his work.

Examination found a large neck mass (8 cm by 5 cm) but was otherwise unremarkable. A chest x ray three months before had been …

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