[Cervical lymph node tuberculosis and tonsils].
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The treatment of lymph node tuberculosis has been studied in 108 patients. Chemotherapy consisted of 18 months' isoniazid with either rifampicin or ethambutol, plus an initial supplement of streptomycin. These 2 regimens were randomly allocated to 19 patients who had previously undergone excision of the lymph nodes, 56 patients who had undergone biopsy and 33 patients who had not had any surgical procedures. The majority of patients were of Indian or Pakistani origin (80%). Histological evidence of tuberculosis was obtained in 64% of the 108 patients and M. tuberculosis was cultured in 30%. No other mycobacteria were grown. Progress during treatment was uneventful in 65% of patients. Fresh nodes appeared during treatment in 12%, existing nodes enlarged in 13% and fluctuation developed in 11% of patients. Discharge and/or sinus formation was infrequent (7%), as was breakdown of a surgical scar (4%). Excision or aspiration after the start of chemotherapy was performed in 19% of patients. In the period up to the end of chemotherapy no difference emerged between the patients who received rifampicin with isoniazid and those who received ethambutol with isoniazid. Satisfactory results were obtained in 98% of the patients by the end of treatment although 13% still had slight node enlargement. The place of surgery is discussed. Follow-up will continue for 18 months after the end of chemotherapy.
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HISTORY AND FINDINGS ON ADMISSION: A 63-year-old female patient was admitted to the authors' hospital for further diagnostic work-up for suspected reactivation of a previously successfully treated lymph node tuberculosis, which had been diagnosed 1 year prior to the current admission. The clinical signs consisted of worsening of the patient's general condition, negacervical lymphadenopathy, night sweats, dyspnea, and superficial inflammation of the right mamma. FINDINGS: A contrast-enhanced CT scan of the neck, thorax and abdomen revealed a generalized enlargement of the cervical, axillar, mediastinal and retroperitoneal lymph nodes, multiple intrapulmonary nodular lesions with a diameter of up to 6 mm, and a substantial right-sided pleural effusion. COURSE OF DISEASE: Under the assumption of reactivation of a lymph node tuberculosis, the patient was initially treated with an extended tuberculostatic therapy. Because of disease progression another lymph node biopsy was performed revealing Hodgkin's disease of mixed-cellularity type with a partly histiocytic necrotizing, partly tuberculoid reaction. The biopsy was negative for acid-fast bacilli. Thereupon initiated chemotherapy according to the ABVD protocol led to a rapid amelioration of the clinical symptoms. CONCLUSION: In the clinical setting of suspected or confirmed lymph node tuberculosis malignant lymphoma should always be considered. This consideration is particular important since Hodgkin's disease is typically associated with a cellular immunosuppression predisposing the subject to tuberculosis.
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