Peripheral lymph node tuberculosis fall into restricted and generalized. Among adults peripheral lymph node tuberculosis is similar to lymph node tuberculosis in children. However, a few points are worth emphasizing.
- In older adults remember the possibility that enlarged nodes may be due to deposits of carcinoma coming from a primary carcinoma in the draining area. Hard nodes behind the inner end of the clavicle are often linked with a lung cancer.
- In adults, as in children, there is usually no fever with tuberculous peripheral lymph nodes. But sometimes there is low fever. Occasionally could be seen very high fever in adults whose chest X-ray show enlarged lymph nodes at the hilum and along the trachea. There may also be enlarged lymph nodes in the neck.
- Development of tubercular granulemas and caseous degenerationo take place in lymphatic nodes.
- Damaged by tuberculosis lymphatic nodes can be elastic and painless. At progressing they become matted together and dense.
The diagnosis is put on the biopsy, with hystologic and bacteriological studies.
The prognosis is good as far as survival is concerned. But if there have been many discharging sinuses, these may result in much scarring.
The tuberculin test is usually positive, but may be negative if there is immunologic insufficiency, malnutrition.
Treatment.
It is still unknown what the lymph nodes will do when you treat them. In about a quarter of patients they may enlarge under treatment. New nodes may even appear. In about 20 per cent an abscess may develop and sometimes sinuses will form. All this is probably a hypersensitivity reaction to the tuberculin released from the killed bacilli. It is not necessary to change treatment if this happens. The nodes will subside if the treatment continue as before. In about 5 per cent of patients it is possible to feel nodes at the end of treatment but usually they do not give further trouble. The current of this form of tuberculosis is wavy, requires persistent chemotherapy, and sometimes (at restricted form) removal of all damaged nodes and excision of fistulas.