TUBERCULOUS LYMPHADENITIS - NOT A LOCALIZED DISEASE PROCESS

Tuberculous lymphadenitis, though a form of extrapulmonary tuberculosis of decreasing incidence in the United States, represents to the U. S. Navy the major form of extrapulmonary disease seen. This report deals with 55 serial admissions to the U. S. Naval Hospltal, St. Albans, New York, with the biopsy-proven diagnosis of tuberculous peripheral lymphadenitis. Significant facts include the relatively short period of active military service, the age distribution with 76% below the age of 30, and the racial distribution revealing a marked predilection for the members of the Negroid, Mongolian, and Malayan races. Ninety-five percent of the patients presented with symptoms. In 11, the symptoms were of such nature as to suggest that the disease was a generalized process and not merely localized to the area of nodal involvement. Laboratory studies were of little diagnostic aid, the group in general presenting with a degree of tuberculin sensitivity similar to a group with pulmonary tuberculosis. A point of significance was an eosinophil count of 3% or more in 65% of the group. Chest roentgenograms were normal in only 39%, 31% of the group presenting with evidence for tuberculous disease other than the adenitis. The chemotherapy for this group consisted of dual drug therapy, one of the drugs being INH [isonicotinic acid hydra-zide], for a minimum of 18 months. Surgical intervention was elected only in those patients with impending tissue breakdown and rupture. Among those with adequate chemotherapy, relapse occured in 1 patient, indicating that relapse is possible even then. Prolonged follow-up is thus necessary for all patients. Tuberculous adenitis is but one facet of a generalized systemic process, and that proper treatment can be selected only if it is so considered.