Diagnostic Dilemma - Pediatric Oncall
Post BCG axillary lymphadenitis
Author: EMAN FOUDA
Question
A 10 months old girl presented with left sided axillary lymphadenitis. There is no other lymphnode enlargement. Chest is clear and there is no fever. These lymph nodes burst spontaneously with caseous material so there is possibility of post BCG lymphadenitis.
Expert Opinion :
Conservative therapy is recommended for non-suppurative cases, although
data are lacking for optimal management {Goraya and Virdi, 2002` Goraya and
Virdi, 2001}. The optimal therapy for suppurative lymphadenitis is also uncertain,
and conservative management, antituberculous chemotherapy, incision and
drainage, and surgical excision have all been employed {Lotte et al., 1988}. In the
immunocompetent individual, gradual resolution with or without spontaneous
drainage generally occurs.

References
Goraya, J.S. and Virdi, V.S. {2001}. Pediatr. Infect. Dis. J. 20, 632–634.
Goraya, J.S. and Virdi, V.S. {2002}. Postgrad. Med. J. 78, 327–329.
Lotte, A., Wasz-Hockert, O., Poisson, N., Engbaek, H., Landmann, H., Quast, U. et al. {1988}. Bull. Int.
Union Tuberc. Lung Dis. 63, 47–59.
Answer Discussion :
S
sanjay wazir
as child is completely asymptomatic, only surgical excision is advisable.
5 years ago
S
Sanjeevcash
If child is Non-HIV Positive and there is no evidence of Disseminated BCG Disease{excluded by No otherlymphadenopathy,hepatosplenomegaly,Chest exam,Xray chest} then conservative t, t in form of Needle aspiration and oral erythromycin is sufficient.A good article for further reading-Annals of Pediatric surgery July2009,Vol-5,no-3,pp 187-193-Dr Sanjeev Aggarwal.
5 years ago
F
fificash ad
INH { for 6 months } plus rifamibicine { for 1 month }
5 years ago
A
Azeem Walele
Should the child be HIV uninfected, no treatment is necessary or at the most further curettage or excision is needed. One should exclude disseminated BCG first. If the child is HIV infected or BCG IRIS is suspected or there are features of disseminated BCG then treatment is required {INH, Rifampicin, PZA, Ethambutol, Ciprofloxacin or Ofloxacin} for 9 months. Exclude Tuberculosis. Monitor for drug toxicity and report as an EPI adverse event. Regards
Azeem Walele South Africa

5 years ago
A
anil prasad
no medication required
5 years ago
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