Hi doctor, I have enlarged lymph node on the neck. FNAC says granulomatous lymphadenitis consistent with Koch's (AFB Stain: negative). In ultrasound it is hypoechoic lesion of approximately 29*34 mm abutting the left submandibular gland but appear separate from it. Simillar lesion of approx. 14*23 mm is seen adjacent to this mass. I have been taking Rifampicin + Isoniazid + Rifampicin + Ethambutol + Pyrazinamide for 22 days and I have also consulted another doctor who says that it needs surgery and asked for digital x-ray of chest. I also gained weight. Please suggest me, should I go for surgery? Currently I am on Forecox 150, Mycobutol 400, Benadon 20 mg, and Neurobion.
Hi. I can understand your concern. According to your statement, you have been suffering from TB lymphadenitis and taking 4FDC (antitubercular drugs) for the last 22 days. Your query is whether surgery is needed for your lymph node or not. Antitubercular medications are enough for curing TB lymphadenitis. Surgery is needed in rare cases. Surgery can be done for diagnostic purposes or therapeutic purposes. Sometimes Fine needle aspiration or biopsy of the lymph node are needed for proper diagnosis of TB lymphadenitis is known as surgery for diagnostic purposes. If TB regimens for 6months or 7months or 9months are failed to subside the lymph node, then surgery is an option. Again during TB treatment if there is any change in size, shape or presence of discharging sinuses or turn into malignancy, then surgical drainage or removal of lymph node may be needed. Otherwise, antitubercular medications are enough to treat TB lymphadenitis. Your physician has advised you to do a CXR (chest x-ray) for the detection of chest involvement. You should undergo CXR. Again Prednisolone 40 mg/day for six weeks followed by gradual tapering over the next four weeks along with your current TB regimens are enough to cure your TB lymphadenitis without any surgery.