Journal of Chest Surgery

  • 제43권6호
  • /
  • Pages.716-720
  • /
  • 2010
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지
DOI QR코드

DOI QR Code

결핵성 경부 림프절염의 임상 양상과 치료

Clinical Features and Treatment of Cervical Tuberculous Lymphadenitis

  • 함석진 (연세대학교 의과대학 강남세브란스병원 흉부외과학교실) ;
  • 백효채 (연세대학교 의과대학 강남세브란스병원 흉부외과학교실) ;
  • 이두연 (연세대학교 의과대학 강남세브란스병원 흉부외과학교실) ;
  • 김관욱 (연세대학교 의과대학 강남세브란스병원 흉부외과학교실) ;
  • 최형윤 (연세대학교 의과대학 강남세브란스병원 흉부외과학교실) ;
  • 유우식 (연세대학교 의과대학 강남세브란스병원 흉부외과학교실)
  • Haam, Seok-Jin (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Paik, Hyo-Chae (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Doo-Yun (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Kwan-Wook (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Choi, Hyung-Yoon (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yu, Woo-Sik (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2010.05.03
  • 심사 : 2010.06.25
  • 발행 : 2010.12.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

배경: 결핵성 경부 림프절염은 말초 결핵성 림프절염의 가장 흔한 형태이다. 미국흉부학회 (American Thoracic Society)에서는 말초 결핵성 림프절염의 치료에 대해 6개월간의 isoniazid와 rifampin, ethambutol, pyrazinamide 투여를 권유하고 있으나 이런 치료에도 불구하고 결핵성 경부 림프절염의 경우는 실제 임상에서 재발하는 환자를 흔하게 볼 수 있다. 대상 및 방법: 1997년 2월부터 2007년 2월까지 본원에서 결핵성 경부 림프절염으로 진단 및 치료를 받은 38명의 의무기록을 후향적으로 분석하여 임상 양상과 치료 효과를 살펴보고자 하였다. 결과: 남자는 14명(36.8%)이었고 여자는 24명(63.2%)이었으며 평균 나이는 $36.9{\pm}16.3$세였다. 다른 특별한 증상 없이 경부의 종괴 촉지로 내원한 환자가 24명(63.2%)으로 가장 많았고 발열과 오한이 10명(26.3%)이었으며, 흉부 방사선 검사상 이상 소견을 보인 환자는 9명(23.7%)에 불과하였다. 모든 환자는 첫 2개월간 isoniazid, rifampin, ethambutol, pyrazinamide의 투여와 5개월 이상의 isoniazid, rifampin, ethambutol을 투여 받아 최소 7개월 이상의 항결핵제를 투여 받았다. 추적관찰 기간 중 7명(21.2%)의 환자에서 재발이 관찰되었다. 결론: 결핵성 경부 림프절염은 대부분의 환자에서 증상이 없고 방사선 검사상에서도 이상 소견을 보이지 않기 때문에 진단과 치료가 늦어지는 경향이 있다. 항결핵제의 투여에도 불구하고 비교적 높은 재발률을 고려할 때, 미국흉부학회에서 권장하는 6개월간의 치료보다는 더 장기간의 치료가 필요할 것으로 생각된다.

Background: Cervical tuberculous lymphadenitis is the most common form of peripheral tuberculous lymphadenitis. The American Thoracic Society recommends 6 months of isoniazid, ritampin, ethambutol and pyrazinamide for treatment of peripheral tuberculous lymphadenifls, but even with this recommended treatment, frequent relapse occurs in actual clinical situations. Material and Method: The medical records of 38 patients diagnosed and treated for cervical tuberculous lymphadenitis between February 1997 and February 2007 were retrospectively reviewed. Result: The study included 14 males (36.8%) and 24 females (63.2%), with a mean age of $36.9{\pm}16.3$ years. The most frequent symptom was palpable neck mass in 24 patients (63.2%); 10 patients (26.3%) complained of fever or chills. Only nine patients (23.7%) had radiologic abnormalities. All patients received anti-tuberculous medications for at least 7 months, with isoniazid, rifampin, ethambutol and pyrazinamide for the first 2 months, and then isoniazid, rifampin and ethambutol given for more than 5 months. Relapse occurred in 7 patients (21.2%). Conclusion: Since many patients with cervical tuberculous lymphadenitis have no symptoms and show no radiologic abnormalities, diagnosis and treatment tend to be delayed. Considering the high relapse rate, the anti-tuberculous medication period should be longer than 6 months and this is recommended by the American Thoracic Society.

키워드

참고문헌

  1. Peto HM, Pratt RH, Harrington TA, et al. Epidemiology of extrapulmonary tuberculosis in the United States, 1993- 2006. Clin Infect Dis 2009;49:1350-7. https://doi.org/10.1086/605559
  2. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005;84:350-62. https://doi.org/10.1097/01.md.0000189090.52626.7a
  3. Bezabih M, Mariam DW, Selassie SG. Fine needle aspiration cytology of suspected tuberculous lymphadenitis. Cytopathology 2002;13:284-90. https://doi.org/10.1046/j.1365-2303.2002.00418.x
  4. Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-62. https://doi.org/10.1164/rccm.167.4.603
  5. Dandapat MC, Mishra BM, Dash SP, et al. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg 1990; 77:911-2. https://doi.org/10.1002/bjs.1800770823
  6. Jha BC, Dass A, Nagarkar NM, et al. Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management. Postgrad Med J 2001;77:185-7. https://doi.org/10.1136/pmj.77.905.185
  7. Alvarez S, McCabe WR. Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals. Medicine (Baltimore) 1984;63:25-55.
  8. Monie RD, Hunter AM, Rocchiccioli KM, et al. Management of extra-pulmonary tuberculosis (excluding miliary and meningeal) in south and west Wales (1976-8). Br Med J (Clin Res Ed) 1982;285:415-8. https://doi.org/10.1136/bmj.285.6339.415
  9. Subrahmanyam M. Role of surgery and chemotherapy for peripheral lymph node tuberculosis. Br J Surg 1993;80: 1547-8 https://doi.org/10.1002/bjs.1800801218
  10. Newcombe JF. Tuberculous cervical lymphadenopathy. Postgrad Med J 1971;47:713-7. https://doi.org/10.1136/pgmj.47.553.713
  11. Wilmot TJ, James EF, Reilly LV. Tuberculous cervical adenitis. Lancet 1957;273:1184-7.
  12. Lau SK, Kwan S, Lee J, et al. Source of tubercle bacilli in cervical lymph nodes: a prospective study. J Laryngol Otol 1991;105:558-61. https://doi.org/10.1017/S0022215100116603
  13. Purohit MR, Mustafa T, Sviland L. Detection of Mycobacterium tuberculosis by polymerase chain reaction with DNA eluted from aspirate smears of tuberculous lymphadenitis. Diagn Mol Pathol 2008;17:174-8. https://doi.org/10.1097/PDM.0b013e31815c1195
  14. Das DK, Francis IM, Sharma PN, et al. Hodgkin's lymphoma: diagnostic difficulties in fine-needle aspiration cytology. Diagn Cytopathol 2009;37:564-73. https://doi.org/10.1002/dc.21064
  15. Campbell IA, Ormerod LP, Friend JA, et al. Six months versus nine months chemotherapy for tuberculosis of lymph nodes: final results. Respir Med 1993;87:621-3.
  16. Jawahar MS, Sivasubramanian S, Vijayan VK, et al. Short course chemotherapy for tuberculous lymphadenitis in children. BMJ 1990;301:359-62. https://doi.org/10.1136/bmj.301.6748.359
  17. Yuen AP, Wong SH, Tam CM, et al. Prospective randomized study of thrice weekly six-month and nine-month chemotherapy for cervical tuberculous lymphadenopathy. Otolaryngol Head Neck Surg 1997;116:189-92. https://doi.org/10.1016/S0194-5998(97)70323-1
  18. Wei YF, Liaw YS, Ku SC, et al. Clinical features and predictors of a complicated treatment course in peripheral tuberculous lymphadenitis. J Formos Med Assoc 2008;107: 225-31. https://doi.org/10.1016/S0929-6646(08)60140-0
  19. Infectious Diseases Society of the Republic of China TSoTT, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, CY Lee's Research Foundation for Pediatric Infectious Disease and Vaccines. Guidelines for chemotherapy of tuberculosis in Taiwan. J Microbiol Immunol Infect 2004;37:382-4.
  20. Hsueh PR, Liu YC, So J, et al. Mycobacterium tuberculosis in Taiwan. J Infect 2006;52:77-85. https://doi.org/10.1016/j.jinf.2005.08.008