PP18 GRANULOMATOUS LYMPHADENITIS - IS IT ALL TUBERCULOSIS? FINDINGS FROM A TERTIARY CENTRE OF HIGH-BURDEN COUNTRY

Nor Syamimi Mohd Isa, Deepa Priya Naidu Subramaniam, Umadevi A. Muthukumaru, Irfhan Hyder Ali.
Hospital Pulau Pinang, Pulau Pinang, Malaysia

Background and Aims

Extrapulmonary tuberculosis (EPTB) accounts for 15% of new TB cases, with TB lymphadenitis being the commonest EPTB. Clinically, TB lymph nodes are difficult to diagnose as presentation varies. Definitive diagnosis through microbiological and histopathological evidence is time and cost-consuming. Often, clinicians are forced to empirically treat based on clinical and non-specific cytological findings. We aimed to gather data on clinico-demographic profile, microbiological aspects and treatment outcomes of our tuberculous lymphadenitis patients.

Methods

All patients referred to Respiratory Clinic for suspected TB lymphadenitis based on cytomorphologic features from May 2023 to May 2024 were included in this study. Data on sociodemographic, the involved lymph nodes, cyto-histopathological results and treatment outcomes were all recorded.

Results

51 patients were included in the final analysis, displaying almost equal gender distribution. The mean age of our cohorts is 38. Immunocompromised state is a major risk factor for TB lymphadenitis - HIV and autoimmune disease were noted in 11(22%) and 3(6%) patients, respectively. 79% had cytomorphology presence of granuloma with caseation/necrosis, while 13% were diagnosed through microbiological methods and PCR. Three cases were empirically treated solely on clinical findings. In terms of outcomes, 80.4% of patients exhibited good treatment response with resolution and reduced lymphadenopathy. Only 3 patients had persistent lymphadenitis and 1 patient experienced paradoxical response. We observed 1 multi-drug resistant case in patient who is immunocompromised with history of default. Out of 51 referred patients, 9% was not commenced on treatment as clinically not suggestive of TB lymphadenitis.

Conclusion

Majority of patients with suggestive cytomorphologic findings positively responded to anti-tubercular therapy. Yet combination with microbiological and molecular methods would further improve diagnostic accuracy in equivocal and TB-mimics cases, especially in immunocompromised.