EFFECTIVENESS OF EMPIRIC ANTITUBERCULAR THERAPY TO TREAT CERVICAL GRANULOMATOUS LYMPHADENOPATHY AMONG PATIENTS NOT CONFIRMED TO HAVE MYCOBACTERIUM TUBERCULOSIS INFECTION

In high prevalence areas, tuberculosis is a common cause of cervical lymphadenopathy. We aimed to determine the efficacy of antitubercular therapy (ATT) to treat patients with cervical granulomatous lymphadenitis, in whom there was no evidence of Mycobacterium tuberculosis infection, in order to determine if this method is a viable strategy to manage these patients at the study institution. We retrospectively reviewed the medical records of patients who presented to Hatyai Hospital, Thailand, had biopsy proven cervical granulomatous lymphadenitis without evidence of M. tuberculosis infection and were treated with empiric ATT during January 2015-December 2019. A total of 69 subjects were included in the study, 71.0% female. The mean (±standard deviation) age of study subjects was 43.1 (±13.7) years. Pathology of the lymph nodes of these 69 subjects showed 38 (55.1%) had caseous necrosis, 23 (33.3%) had nonspecific necrosis and 8 (11.6%) had no necrosis. Sixty-three subjects (91.3%) (100% with caseous necrosis and 80.6% with non-caseous necrosis, p=0.006) had complete resolution of their cervical granulomatous lymphadenopathy with ATT. In summary, the great majority of subjects with cervical granulomatous lymphadenopathy and all those with caseous lymphadenopathy, were treated successfully with ATT. We conclude, patients with cervical granulomatous lymphadenitis at the study institution can be treated with ATT, even if there is no evidence of M. tuberculosis. Further studies at other institutions need to be conducted to determine if this finding can be applied to other institutions in Thailand.