TB Lymphadenitis — SCE Infectious Diseases MCQ

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EasyTuberculosisTB LymphadenitisSCE Infectious Diseases

A 28-year-old man from Ethiopia presents with bilateral painless cervical lymphadenopathy. Fine needle aspirate shows caseating granulomata with AFB on ZN stain. GeneXpert confirms M. tuberculosis. Chest X-ray is normal. What is the recommended treatment duration for lymph node TB?

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Correct answer: A — 6 months (2RHZE/4RH) — same as pulmonary TB

Peripheral lymph node TB (the most common form of extrapulmonary TB in the UK) is treated with the same standard 6-month regimen as pulmonary TB: 2 months RHZE then 4 months RH. Extended treatment (9–12 months) is not routinely recommended for lymph node TB unless there is co-existing CNS/bone involvement. Paradoxical reactions (enlarging or new nodes during treatment) are common and do not indicate treatment failure — they represent immune reconstitution and are managed expectantly or with corticosteroids if severe.

Reference: NICE NG33 2016 – TB; BTS 2024 – Extrapulmonary TB