Isolated Peripheral Tuberculous Lymphadenitis: Insights into Diagnostic Delays and Clinical Challenges
Methods: We retrospectively analyzed 30 adult patients diagnosed with TB- LAP at a tertiary care center between 2021 and 2025. Inclusion criteria were isolated peripheral lymphadenopathy with compatible histopathology, supported by culture, PCR, or clinical-radiological findings. Data regarding diagnostic delay, referral pathways, microbiological yield, and treatment outcomes were collected.
Results: Among 158 peripheral lymphadenopathy cases, 52 were diagnosed as TB-LAP, and 30 with complete follow-up data were included in the final analysis. The mean age was 39.2 years, and 83.3% were female. Culture positivity was 28.6%, Polymerase Chain Reaction (PCR) 42.9%, and acid-fast bacilli were detected in only one patient. Overall microbiological confirmation rate was 23.3%. Treatment was successfully completed in most cases, with treatment-related complication rate of 6.7%. Diagnostic delay ≥2 months was observed in 56.7% of patients. Early referral to the infectious diseases clinic significantly reduced diagnostic delay (<2 months in 72.7% vs. 15.4% in internal medicine; P=0.017). Histopathology most frequently showed granulomatous inflammation, while caseating necrotizing inflammation (23.3%) was the strongest supportive finding.
Conclusions: In this 30-case series of isolated peripheral TB-LAP, histopathology - supported by PCR when available - provided the most reliable diagnostic contribution, while culture remained limited in keeping with the paucibacillary nature of the disease. The findings highlight the need for more sensitive molecular tools, yet indicate that, for now, timely tissue sampling and careful clinical–pathological interpretation remain the most dependable approach in routine practice.
1. World Health Organization. Global Tuberculosis Report 2023. Geneva: WHO; 2023. Available at: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2023.(Accessed:August 31, 2025)
2. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005v;84(6):350-362. doi: 10.1097/01.md.0000189090.52626.7a.
3. Mathiasen VD, Eiset AH, Andersen PH, Wejse C, Lillebaek T. Epidemiology of tuberculous lymphadenitis in Denmark: A nationwide register-based study. PLoS One. 2019;14(8):e0221232. doi: 10.1371/journal.pone.0221232.
4. Sivaratnam L, Nawi AM, Abdul Manaf MR. An evidence-based clinical pathway for the diagnosis of tuberculous lymphadenitis: A systematic review. Int J Mycobacteriol. 2020;9(2):107-115. doi: 10.4103/ijmy.ijmy_207_19.
5. Purohit M, Mustafa T. Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need. J Clin Diagn Res. 2015;9(4):EE01-6. doi: 10.7860/JCDR/2015/12422.5792.
6. Kumar N, Khan A, Boora S, et al. Diagnosis of tuberculous lymphadenitis by molecular and immunological tools. Med Microecol. 2024;22:100116. doi: 10.1016/j.medmic.2024.100116.
7. Republic of Türkiye, Ministry of Health. Tuberculosis Control in Türkiye 2021 Report. Ankara: Republic of Türkiye Ministry of Health; 2021. Available at: https://hsgm.saglik.gov.tr. (Accessed: August 31, 2025).
8. Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med. 2018 ;18(3):91-93. doi: 10.1016/j.tjem.2018.08.001.
9. Celik M, Gurbuz E, Cicek Y, et al. Demographic, clinical and laboratory characteristics of extrapulmonary tuberculosis: Eight-year results of a multicenter retrospective study in Turkey. J Investig Med. 2025;73(2):206-217. doi: 10.1177/10815589241299367.
10. Gupta V, Bhake A. Diagnosis of clinically suspected and unsuspected tubercular lymphadenopathy by cytology, culture, and smear microscopy. Indian J Tuberc. 2017;64(4):314-317. doi: 10.1016/j.ijtb.2016.11.014.
11. Méchaï F, Macaux L, Jeny F, et al. Granulomatous lymphadenopathy and tuberculosis: accuracy of histology. Int J Infect Dis. 2025;156:107920. doi: 10.1016/j.ijid.2025.107920.
12. Walker CW, Hulsey B, Pompa M. Evaluating lymphadenopathy. JAAPA. 2025;38(6):20-27. doi: 10.1097/01.JAA.0000000000000212.
13. Yenilmez E, Özakınsel D, Köse A, et al. Diagnostic approach of tuberculous lymphadenitis in a multicenter study. J Infect Dev Ctries 2024;18(5):742-750. doi: 10.3855/jidc.19502.
14. Fukushima K, Akagi K, Kondo A, Kubo T, Sakamoto N, Mukae H. First clinical evaluation of the QIAreachTM QuantiFERON-TB for tuberculosis infection and active pulmonary disease. Pulmonology. 2022;28(1):6-12. doi: 10.1016/j.pulmoe.2021.07.003.
15. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A. Peripheral lymphadenopathy: approach and diagnostic tools. Iran J Med Sci. 2014;39(Suppl):158-170.
16. Sunnetcioglu A, Sunnetcioglu M, Binici I, Baran AI, Karahocagil MK, Saydan MR. Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases. Ann Clin Microbiol Antimicrob. 2015;14:34. doi: 10.1186/s12941-015-0092-2.
17. Öztomurcuk D, Terzi Ö, Demirci C, Kılıçaslan Z. Investigation of Granulomatous Inflammations in Terms of Tuberculosis Diagnosis: A 5-Year Multi-center Laboratory Study. Turk Thorac J. 2022;23(1):11-16. doi: 10.5152/TurkThoracJ.2022.20314.
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Article Information
- Article Type Research Article
- Submitted February 21, 2026
- Published January 3, 2026
- Issue Volume 12 - Issue 1 (January 2026)
- Section Research Article
