From the Guidelines
Tuberculosis (TB) causes axillary lymphadenitis through lymphatic spread of Mycobacterium tuberculosis bacteria from a primary infection site, typically the lungs, leading to a granulomatous inflammatory response and potential complications if left untreated. After initial infection, the bacteria enter the lymphatic system and travel to regional lymph nodes, including those in the axilla (armpit) 1. Once in the lymph nodes, M. tuberculosis triggers a granulomatous inflammatory response characterized by the formation of granulomas containing infected macrophages, epithelioid cells, and multinucleated giant cells. These granulomas may undergo caseous necrosis, leading to the characteristic "cold abscess" without significant heat or redness. The infected axillary lymph nodes become enlarged, firm, and sometimes matted together. They may eventually suppurate and form draining sinuses if left untreated.
Key points to consider in the management of TB lymphadenitis include:
- A 6-month regimen of anti-TB therapy is recommended for initial treatment of all patients with drug-susceptible tuberculous lymphadenitis 1
- Affected lymph nodes may enlarge and new nodes can appear during or after therapy without any evidence of bacteriological relapse 1
- Therapeutic lymph node excision is not indicated except in unusual circumstances, such as large fluctuant nodes or those not responding to medical therapy 1
- Aspiration or incision and drainage may be beneficial for large fluctuant nodes, although this approach has not been examined systematically 1
It is essential to note that the majority of cases of lymphatic mycobacterial disease in children in the United States are caused by nontuberculous mycobacteria 1. Therefore, a thorough diagnosis and consideration of the causative agent are crucial in the management of axillary lymphadenitis. Treatment requires a standard anti-TB regimen consisting of isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and rifampin for an additional 4 months, totaling 6 months of therapy.
From the Research
TB and Axillary Lymphadenitis
- Tuberculosis (TB) can cause axillary lymphadenitis, which is a rare condition 2.
- Axillary lymph node tuberculosis often poses problems of differential diagnosis, especially with breast carcinoma 2.
- The exact mechanism of how TB causes axillary lymphadenitis is not clearly explained in the provided studies.
Diagnosis and Treatment
- TB diagnosis and treatment regimens have been established, but the provided studies do not specifically address how TB causes axillary lymphadenitis 3, 4.
- Studies have investigated the pharmacokinetics of anti-TB drugs and their interactions, but these do not provide insight into the causation of axillary lymphadenitis 3, 5.
- The treatment of latent TB infection and active TB has been updated, but the provided studies do not discuss the relationship between TB and axillary lymphadenitis 4, 6.
Limitations
- There are no research papers among the provided studies that directly explain how TB causes axillary lymphadenitis.
- Further research is needed to understand the relationship between TB and axillary lymphadenitis.