The application of ultrasound criteria for malignancy in differentiating tuberculous cervical adenitis
from metastatic nasopharyngeal carcinoma.
Other high suspicion scenarios include prolonged fever with unexplained/culture-negative shock, or antibiotic treatment failure for cervical adenitis
or retro/parapharyngeal phlegmon.
Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis
syndrome (PFAPA) seen with periodic fever is first described by Marshall et al.
Almost similar results are reported in a study conducted in Kathmandu, in which causes of cervical lymphadenopathy were tuberculous lymphadenitis (54%), reactive hyperplasia (33%) and metastatic lesion in lymph nodes (11.1%).15 Our reports are in tandem with another local study in which out of total 220 patients with enlarged neck lymph nodes, tuberculous lymphadenitis was the most common occurrence (70.45%).16,17 All of the tuberculous patients studied by Chaudry N, 58% presented with cervical adenitis
It is manifested as recurrent episodes of fever associated with tonsillitis, aphthous ulceration, stomatitis, and cervical adenitis
. It is initially described in children by Marshall in 1987 [1, 2].
Sometimes periodic fever, aphtous stomatitis, pharyngitis, and cervical adenitis
(PFAPA) syndrome mimic FMF symptoms and these patients respond to colchicine.
Medical uses of radiation for various diseases like Thymus enlargement, Tinea capitis, Tonsillitis, Cervical adenitis
, Bronchitis, Hemangioma, Cystic acne, Eustachian tubes etc., was very popular during 1900-1960 but no more.
American College of Rheumatology describes PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis
) as "a syndrome that consists of recurrent episodes of fever, sore throat, mouth sores and swelling of the glands in the neck ...
PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis
) is an autoinflammatory disorder characterized by recurrent attacks of high fever associated with cervical adenitis
, pharyngitis and aphtous stomatitis .
This is consistent with a study in which among 147 clinically suspected cases, 107 (72.8%) were confirmed as tuberculous lymphadenitis by fine-needle aspiration (FNA) cytology and acid-fast bacillus (AFB) smear examination.10 One local study11 reported that 70% of patients had tuberculous infection diagnosed on the basis of either FNAC or excisional biopsy while another study12reported an incidence of tuberculosis to be 57.2%.Choudaryet al.13 reported that all of the tuberculous patients they studied, 58% had cervical adenitis
The syndrome is called periodic fever associated with aphthous stomatitis, pharyngitis and cervical adenitis
-- or PFAPA -- and is characterized by monthly flare-ups of fever, accompanied by sore throat, swollen glands and mouth lesions.
The term cervical adenitis
denotes an inflammation of the lymph nodes due to an infectious process (Figure 1A) Suppurative adenitis indicates an infected node which has undergone liquefaction necrosis (Figure 1B).