Cervical tuberculous lymphadenitis, accounting for 80% of cases, is commonly observed in children and adolescents.
Etiology
The causative pathogen is Mycobacterium tuberculosis. The infection of cervical lymph nodes can occur either through lymphatic or hematogenous spread. Tuberculosis of the nasopharynx, oral cavity, or larynx often causes cervical lymph node infection via submucosal lymphatic drainage. Tuberculosis of the lungs can infect cervical lymph nodes through hematogenous or lymphatic pathways.
Clinical Manifestations
Some patients may present with systemic symptoms of tuberculosis, such as fatigue, low-grade fever, night sweats, reduced appetite, and weight loss. Multiple enlarged cervical lymph nodes may appear unilaterally or bilaterally, in superficial or deep regions, usually located in areas such as the submandibular region and the anterior or posterior border of the sternocleidomastoid muscle.
In the early stages, the enlarged lymph nodes are separate, mobile, and painless. Over time, the enlarged nodes may adhere to each other, forming a bead-like chain with slight tenderness. If secondary infections occur, tenderness tends to become more pronounced. The lymph nodes often become adherent to the skin and surrounding tissues, reducing their mobility.
In advanced stages, caseous necrosis may occur in the swollen lymph nodes, leading to the formation of cold abscesses. At this point, the overlying skin becomes shiny and purplish-red, and a fluctuant sensation may be detected upon palpation. The abscess may rupture through the skin, forming non-healing ulcers or sinus tracts that discharge thin pus-like fluid. Some patients may exhibit symptoms of pulmonary and laryngeal tuberculosis, such as coughing, hemoptysis, and laryngeal pain.
Diagnosis
The diagnosis can usually be established when multiple enlarged cervical lymph nodes appear unilaterally or bilaterally, forming bead-like chains with adhesion to the skin and surrounding tissues, or when non-healing sinus tracts develop after lymph node rupture. Chest X-rays or CT scans, indirect laryngoscopy, and posterior rhinoscopy may detect pulmonary, laryngeal, or nasopharyngeal tuberculosis. Tuberculin skin tests, tuberculosis antibody tests, and erythrocyte sedimentation rate measurements provide additional diagnostic support.
Differential diagnosis is required to distinguish this condition from chronic cervical lymphadenitis, primary cervical malignancies, and metastatic malignancies.
Treatment
General Management
Nutritional support and physical strengthening measures are utilized.
Anti-Tuberculosis Therapy
Commonly used medications include isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin.
Local Treatment
For patients with abscesses or sinus tracts, procedures such as abscess drainage and irrigation followed by the instillation of anti-tuberculosis drugs can be performed.
Immunotherapy
Treatments may involve the use of transfer factors, levamisole, immunoribonucleic acid, or intramuscular injection of Bacillus Calmette-Guérin (BCG) polysaccharide nucleic acid preparation.
Surgical Excision
Routine surgical excision is generally not recommended. For certain cases involving large, isolated lymph nodes refractory to conservative treatment, surgical excision may be considered.