Tuberculous lymphadenitis


  • Also known as "scrofula" when involves cervical lymph nodes
  • Most common form of extrapulmonary TB
  • TB causes up to 43% of peripheral lymphadenopathy in the developing world [1]
  • In the US, more common among Asian Pacific Islanders and in females
  • Most cases occur in the setting of reactivation of latent infection

Clinical Features

  • Enlarging, painless, red, firm, mass, most commonly in the anterior or posterior cervical chain
  • Can be complicated by ulceration, fistula, or abscess formation
  • Systemic signs and symptoms are uncommon, except patients with HIV (in whom lymphadenitis is usually generalized)

Differential Diagnosis




Neck mass


Subacute (weeks to months)


  • Thyroid nodules or cancer
  • Goiters
    • Graves' disease
    • Hashimoto thyroiditis
    • Iodine deficiency
    • Lithium use
    • Toxic multinodular
  • Congenital cysts
    • Branchial cleft cyst
    • Thyroglossal duct cyst- 2nd most common benign neck mass
    • Dermoid cyst
  • Carotid body tumor
  • Glomus jugulare or vagale tumor
  • Laryngocele
  • Lipoma/liposarcoma
  • Parathyroid cysts or cancer


  • Fine needle aspiration: sensitivity and specificity (77 and 93% respectively)[2]
  • Excisional biopsy (if FNA is not diagnostic)
    • highest diagnostic yield
    • Submit specimens for histology, culture, and Nucleic acid amplification testing
    • caseating granulomas on histopathology is highly suggestive of TB
  • CT can be useful to identify involved lymph nodes for biopsy
  • CXR: most do not have evidence of active pulmonary TB in nonendemic countries
  • Sputum smear and culture: positive only in approximately 20% of cases[3]


  • Medical therapy
    • 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
  • Surgical excision may be performed if medical therapy fails
  • Do not I&D, can result in permanent sinuses and prolonged drainage

See Also


  1. 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.
  2. Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.
  3. Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.
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