Suggest remedy for granulomatous lymphadenopathy with tuberculosis sarcoidosis
Patient: Excision biopsy of cervical lymphadenopathy on the right side in 2004 showed confluent epithelioid granulomas.  Areas of hyalinization and necrosis also seen.  Multinucleite giant cells of Langhans type noted.  Z-N staining did not reveal acid fast bacilli despite intensive search.  No atypical cells observed.  Diagnosis:  Granulomatous lymphadenopathy ?tuberculosis ?? sarcoidosis.  Bactec culture showed no growth of Mycobacterium species after 6 weeks of incubation.  In Feb 2010 granulomatous lymphadenitis on the left side of the neck with FNAC showing epithelioid cells present as single cells or clusters.  Occasional multinucleated giant cell is seen.  No caseation identified.  What could be the diagnosis for this cervical lymphadenopathy? Doctor: Thanks for your question on Healthcare Magic.I can understand your concern. In my opinion, this patient should start anti tubercular drugs according to weight.Tubercular Lymphadenopathy is much more common than sarcoidosis. Sarcoidosis is more common in mediastinal lymphnode. TB is more common in cervical lymphnode. So even if culture is negative, absence of caseation necrosis, we should definitely go for anti tubercular drugs for atleast 6-8 months. Hope I have solved your query. I will be happy to help you further. Wishing good health to your patient. Thanks.