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Posted On : 10 Nov 2024

A 6-year-old male, 22 kg came with complaints of bilateral multiple cervical enlarged lymph nodes since the last six months. History of pain and increase in size of lymph node since last 3 days. No h/o fever, cough, cold. past history is not significant. No h/o swelling at any other site. General examination reveals bilaterally enlarged, and firm. not-matted, non-tender lymph nodes around 1cm in size.systemic examination normal.a short course of antibiotics was prescribed by a physician followed by which pain subsided but the enlarged lymph node still persists. h/o kochs in grandfather since last 2 years. He was advised CBC and ESR, MT, fnac of LN, and chest x-ray. CBC was within normal limits, ESR-54, MT negative, FNAC showed reactive lymphadenitis and chest x-ray was normal. What shall be the further line of management?

Expert Answer :

Answer Discussion :

A

Ayfokir Bogale

0

6y6

1 month ago

M

Munashe Muzerengi

0

Biopsy

1 month ago

A

Abdalla Almatbagi

1

Observe Frequent Follow up

1 month ago

V

vinod tulachan

0

history six month with no localising sign , size 10 mm , wait and watch,

1 month ago

H

Hazrat bilal Khan

0

wait nd see...

1 month ago

Answer 1

Child is 6 years old and for his age the weight centiles are appropriate. the fact that his grandfather has had tuberculosis for the last 2 years{ without resolving may suggest MDR Koch as 2 years is a prolonged treatment for drug-sensitive tuberculosis} gives a high suspicion that he is suffering from the same.
Any cervical lymph node predominantly the inflamed ones would be treated with a proper 7-10 days on antibiotics and if there is no resolution of size or symptoms then an FNAC is planned.
the child has high ESR and FNAC showed reactive lymphadenitis. To mention initially FNAC in tuberculosis can show a similar picture if the site of doing is not adequate. MT negative does not hold significance here as age is More than 5 years and anyways either positive or negative would not have made a real difference.
The next line of management should be to do an excision biopsy of the lymph node and send it for histopathological examination and TB MGIT culture with bacterial culture. These two investigations should help us in the further management of these cases depending upon their reports.
If Koch is seen in histopathological examination then he warrants 4drug AKT till culture reports are available.

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