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Residual Lymphadenopathy Post-TB — SCE Infectious Diseases MCQ

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EasyTuberculosisResidual Lymphadenopathy Post-TBSCE Infectious Diseases

A 55-year-old man with TB lymphadenitis completes 6 months of standard anti-TB therapy. At the end of treatment, he has a residual 2 cm cervical lymph node that is firm, non-tender, and non-fluctuant. He is otherwise well with normal inflammatory markers. What is the most appropriate approach?

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Correct answer: B — Observe — residual lymphadenopathy post-TB treatment is common and does not indicate treatment failure if the patient is clinically well and inflammatory markers are normal

Residual lymphadenopathy at the end of TB treatment is common (up to 30–40% of patients with TB lymphadenitis) and does NOT indicate treatment failure. It may represent fibrosis, calcification, or sterile granulomatous material. If the patient is clinically well, has completed the full 6-month course with good adherence, and inflammatory markers are normal, observation is appropriate. Serial monitoring (clinical assessment at 3 and 6 months post-treatment) is reasonable. Biopsy or treatment extension should only be considered if there are features suggesting active infection.

Reference: NICE NG33 2016 – TB; BTS 2024 – Post-treatment TB residual disease