PURPOSE: Tuberculous lymphadenitis (TBLN) is the most common type of extra pulmonary TB in India which is managed with 2 (HRZE) 3 /4HR under RNTCP. In 60% cases, residual lymph nodes are present after completion of 6 months chemotherapy and associated with cold abscess formation and anxiety to patients.Intra lymph node depot methyl prednisolone has strong anti inflammatory property & suppresses TNF α leading to rapid regression in TBLN size.
METHODS: Patients having residual lymph nodes (Res TBLN) after adequate anti TB treatment were enrolled in this study. The number, size, consistency, mobility, and matting were recorded. Patients with cold abscess, diabetes mellitus, HIV, chronic renal failure were excluded.1-2 ml of Inj. Methyl prednisolone acetate (depot) (DMPA) was injected fortnightly into the lymph nodes, depending on the size of lymph nodes.(max thrice). Patients were followed up fortnightly for response and complications. Successful outcome was considered when reduction of more than 50% in size at end of 6 week was achieved. INH & EMB combination was used during DMPA therapy. Every alternate patient was put on same chemotherapy to serve as controls without I/L DMPA.
RESULTS: Out of the 334 patients studied, ≥50% reduction in size was noted in 151 patients (45.20%) in 2 weeks, in 265 patients (79.34%) in 4 weeks, 301 patients (90.11%) in 6 weeks. In control cases, 15% patients had significant reduction in size after completion of 6 weeks additional INH + EMB treatmentComplications observed in the study were transient pain at injection site (8%) unilateral chest pain, and pain radiating to arm. Cold abscess, sinus formation, extension of lesion, was not observed.
CONCLUSION: Intra lymph node Inj. Methyl Prednisolone Acetate (depot) accelerates the reduction of size of tuberculous lymph nodes, without causing systemic or local side effects when given with INH +EMB cover.
CLINICAL IMPLICATIONS: Intra lymph node Inj. Methyl Prednisolone Acetate (depot) accelerates the reduction of size of tuberculous lymph nodes, without causing systemic or local side effects when given with INH +EMB cover.
DISCLOSURE: GUPTA RAKESH, No Financial Disclosure Information; No Product/Research Disclosure Information