Tuberculous Lymphadenitis

Epidemiology

There is a dramatic rise in the prevalence of tuberculosis in industrialized countries due to the acquired immunodeficiency syndrome (AIDS) epidemic, drug abuse, and increased migration. The most common form of head and neck tuberculosis is lymphadenitis. This form of tuberculosis represents 15% of cases of extrapulmonary disease and 1 to 2% of all new cases of tuberculosis.

Clinical Findings

Cervical lymphadenopathy is usually painless. Involvement is commonly bilateral and most frequently involves the internal jugular, posterior triangle, and supraclavicular nodes. In advanced stages, the overlying skin may be inflamed and sinus tracts may appear. Systemic symptoms are not common in tuberculosis confined to cervical nodes. When tuberculosis is suspected, a chest radiograph should be obtained because 40 to 70% of patients have signs of active or healed pulmonary tuberculosis. Skin tests and sputum examination should also be performed. Nodal biopsy may be necessary to confirm diagnosis if these tests appear equivocal.