Diagnostic Dilemma

Post BCG axillary lymphadenitis

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.

Should we give antituberculous therapy and how many medications are to be used and for how long_?
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.

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 :
sanjay wazir
as child is completely asymptomatic, only surgical excision is advisable.
12 years ago
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.
12 years ago

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