What is the indication for surgery in case of lymphadenitis?

Question

Hi doctor,

I have an enlarged lymph node in the neck. FNAC shows granulomatous lymphadenitis, consistent with Koch's (AFB stain: negative). On ultrasound, it is a hypoechoic lesion measuring approximately 29 × 34 mm, abutting the left submandibular gland but appearing separate from it. A similar lesion measuring approximately 14 × 23 mm is seen adjacent to this mass. I have been taking Rifampicin + Isoniazid + Ethambutol + Pyrazinamide for 22 days, and I have also consulted another doctor who says that I need surgery and asked for a digital x-ray of the chest. I also gained weight.

Please tell me, should I go for surgery? Currently, I am on Forecox 150, Mycobutol 400, Benadon 20 mg, and Neurobion.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern. According to your statement, you have been suffering from TB lymphadenitis and taking 4FDC (antitubercular drugs) for the last 22 days. Your query is whether surgery is needed for your lymph node or not.

Antitubercular medications are enough for curing TB lymphadenitis. Surgery is needed in rare cases. Surgery can be done for diagnostic purposes or therapeutic purposes. Sometimes fine needle aspiration or biopsy of the lymph node is needed for proper diagnosis of TB lymphadenitis, which is known as surgery for diagnostic purposes.

If TB regimens for 6 months or 7 months or 9 months fail to subside the lymph node, then surgery is an option. Again, during TB treatment, if there is any change in size, shape, or presence of discharging sinuses, or if it turns into malignancy, then surgical drainage or removal of lymph nodes may be needed. Otherwise, antitubercular medications are enough to treat TB lymphadenitis.

Your physician has advised you to do a CXR (chest x-ray) for the detection of chest involvement. You should undergo CXR. Again Prednisolone 40 mg/day for six weeks followed by gradual tapering over the next four weeks along with your current TB regimens is enough to cure your TB lymphadenitis without any surgery.

I hope this helps.