Tuberculosis (TB) continues to be a significant global health burden, with millions of new cases reported annually, especially in low- and middle-income countries. While pulmonary TB remains the most common presentation, extrapulmonary tuberculosis (EPTB) constitutes a substantial proportion of cases, accounting for nearly 15-20% of all TB manifestations, and up to 50% in HIV co-infected individuals (1,2). Among the various forms of EPTB, tuberculosis lymphadenitis (TBLN) is the most frequently encountered type, particularly in endemic regions (3).

TBLN predominantly involves the cervical lymph nodes and typically presents as a painless, slowly enlarging mass in the neck. Constitutional symptoms such as fever, weight loss, and night sweats may be present but are not universal (4). The disease is more prevalent in younger populations and demonstrates a female preponderance in several reported series (5,6). Diagnostic challenges often arise due to the nonspecific nature of symptoms and overlapping clinical features with other causes of lymphadenopathy, such as malignancy or reactive hyperplasia (7).

Fine-needle aspiration cytology (FNAC) remains a widely used initial diagnostic tool due to its simplicity, cost-effectiveness, and relatively high sensitivity and specificity in detecting granulomatous inflammation suggestive of TB (8). However, in cases where FNAC results are inconclusive, excisional biopsy or molecular diagnostic techniques such as GeneXpert MTB/RIF may be necessary for confirmation (9,10).

Treatment of TBLN relies on the conventional anti-tubercular therapy (ATT) regimen, as recommended by the World Health Organization (WHO) and national TB control programs. Most patients respond favorably to the standard six-month therapy, although paradoxical reactions, persistent lymphadenopathy, and recurrence can occur in some cases (11,12). Regular follow-up is essential to monitor treatment adherence, therapeutic response, and potential complications (13).

This study was undertaken to evaluate the clinical presentation, diagnostic profile, and treatment outcomes of patients diagnosed with tuberculosis lymphadenitis in a tertiary care hospital. By analyzing local epidemiological patterns and response to therapy, the study aims to enhance early recognition and optimize management strategies for TBLN.

A total of 120 patients presenting with peripheral lymphadenopathy suspected to be of tubercular origin were enrolled. Inclusion criteria included age above 15 years, clinical features suggestive of tuberculosis lymphadenitis, and confirmation by at least one diagnostic modality such as fine-needle aspiration cytology (FNAC), histopathology, or microbiological methods. Patients with known malignancy, HIV infection, or other causes of lymphadenopathy were excluded.

Clinical Evaluation:

All participants underwent a detailed clinical examination, including assessment of lymph node size, number, location, tenderness, presence of matting, and systemic symptoms like fever, night sweats, weight loss, and fatigue. Past history of tuberculosis, contact with known TB patients, and history of anti-tubercular therapy (ATT) were documented.

Diagnostic Investigations:

Initial evaluation included routine hematological and biochemical tests, erythrocyte sedimentation rate (ESR), chest radiography, and Mantoux test. FNAC was performed in all patients to evaluate cytological evidence of granulomatous inflammation. In cases with inconclusive FNAC, excisional biopsy was carried out. Additional tests such as Ziehl-Neelsen staining for acid-fast bacilli (AFB), mycobacterial culture, and GeneXpert MTB/RIF assay were employed where indicated.

Treatment and Follow-Up:

Patients diagnosed with tuberculosis lymphadenitis were initiated on standard first-line anti-tubercular therapy (Category I regimen) as per national guidelines, comprising a 2-month intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by a 4-month continuation phase with isoniazid and rifampicin. Patients were followed up at 2, 4, and 6 months during the course of treatment. Treatment adherence, clinical response, residual lymphadenopathy, and any adverse drug reactions or complications were recorded.

Data Analysis:

The data collected were entered into Microsoft Excel and analyzed using SPSS software version 25. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to summarize categorical and continuous variables. Treatment outcomes were classified as complete response, partial response, or recurrence.

A total of 120 patients with confirmed tuberculosis lymphadenitis were included in the study. The mean age of the study population was 28.4 ± 11.2 years, with a range of 16 to 65 years. The majority of patients were female (n = 78; 65%), and the rest were male (n = 42; 35%) (Table 1).

Table 1: Age and Gender Distribution of Patients

Cervical lymph nodes were the most commonly affected site, observed in 101 (84.1%) patients. Axillary and supraclavicular involvement was noted in 9 (7.5%) and 6 (5%) patients, respectively. Generalized lymphadenopathy was seen in 4 (3.3%) cases (Table 2).

Table 2: Distribution of Lymph Node Involvement

FNAC provided diagnostic cytological features of tuberculosis in 86 patients (71.7%). Excisional biopsy was required in 28 (23.3%) patients due to inconclusive FNAC, while GeneXpert confirmed TB in 6 (5%) cases (Table 3).

Table 3: Diagnostic Modalities Used

Systemic symptoms included fever in 73 (60.8%) patients, weight loss in 57 (47.5%), and night sweats in 39 (32.5%) (Table 4).

Table 4: Frequency of Systemic Symptoms

Following the 6-month ATT regimen, 105 (87.5%) patients achieved complete resolution of lymphadenopathy. A partial clinical response was observed in 10 (8.3%) patients, and 5 (4.2%) cases experienced recurrence within three months of completing therapy (Table 5).

Table 5: Treatment Outcome After 6 Months of ATT

As shown in Tables 1 to 5, the majority of patients were young females with cervical lymphadenopathy and responded well to first-line anti-tubercular treatment. FNAC remained the primary diagnostic tool, while a minority required excision biopsy or molecular confirmation. Overall, favorable treatment outcomes were achieved in most cases.

Tuberculosis lymphadenitis remains a common form of extrapulmonary TB, particularly in developing countries where the overall burden of tuberculosis continues to be high (1). In this study, a predominance of young female patients with cervical lymphadenopathy was noted, aligning with previous findings that suggest female preponderance and involvement of the cervical region as the hallmark of this condition (2,3). Several studies have hypothesized hormonal and immunological differences as contributing factors to the gender variation in TBLN incidence (4,5).

The majority of patients in our study were in the age group of 15–34 years, consistent with other reports that indicate higher prevalence in young adults, possibly due to increased exposure and immune susceptibility during reproductive years (6). The most common clinical presentation was painless neck swelling, followed by constitutional symptoms such as fever, weight loss, and night sweats, which is in agreement with the typical presentation described in both classical and contemporary literature (7,8).

FNAC proved to be an effective initial diagnostic modality in over 70% of cases in our cohort, supporting previous studies that highlighted its utility as a rapid, cost-effective, and relatively accurate technique in resource-limited settings (9,10). However, a significant proportion required excisional biopsy, especially when cytology was inconclusive, underscoring the importance of histopathology in difficult cases (11). Molecular diagnostics such as the GeneXpert MTB/RIF assay were useful in a few cases, particularly when there was diagnostic uncertainty or concern for drug resistance (12).

Treatment outcomes were favorable in the vast majority of patients, with over 85% achieving complete resolution of lymphadenopathy following the six-month ATT regimen. This observation aligns with studies that affirm the efficacy of the standard DOTS-based therapy for TBLN, provided there is good compliance and early initiation of treatment (13,14). However, partial responses and recurrence were noted in a small percentage of patients, which may be attributable to factors such as delayed diagnosis, poor adherence, or underlying immune suppression (15).

Tuberculosis lymphadenitis remains a significant clinical presentation of extrapulmonary TB, particularly among young adults and females. Cervical lymph node involvement is most common, with FNAC being an effective initial diagnostic tool. The majority of patients respond well to standard anti-tubercular therapy. Early diagnosis, appropriate intervention, and regular follow-up are essential for favorable outcomes and minimizing complications

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