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I Had Been In The US For Almost A Month
Question: I had been in the US for almost a month and returned back. After about 10 days, I started to notice a small lump near my right neck. There was no pain and the swelling was neither increasing nor decreasing. I reached out to my GP and he ordered to start with paracetmol based drug for a wk to see if the swelling subsides. There wasn't much change in the lump (lymph node) swelling and he suggested for a neck sonography.
Internally, there were a few of the lump nodes observed during the investigation. To ascertain further, my dr. ordered a FNAC from right cervical lymph node.
I am not sure if the reports are suggestive of a possible lymph-node TB. I don't have anyother symptoms like fever, rash, night sweats, weight reduction etc related to the usual symptoms.
I am attaching the reports alongwith this for your perview. Kindly go through them as I am looking for a second opinion about the course of the treatment that has been suggested.
The dr. also informed me the duration of treatment is for about 6 months but has given the current medicine for 15 days to analyze the treatment/side affects.
Is this really TB that is existent in lymph nodes? I am not sure if the report of the FNAC test co-relates with TB.
As XXXXXXX is really known for having too many wrong diagnosed cases and I don't want to be one of those.
Please review and let me know your suggestion. I am very much confused as after taking the TB medicine for a couple of weeks, the enlarged lymph node hasn't subsided. Is it really TB or something else that needs to be investigated.
Also, I have completed two wks treatment and my liver (SGPT and SGOT) along with Uric acid levels have risen significantly. Attaching the reports for your reference
Internally, there were a few of the lump nodes observed during the investigation. To ascertain further, my dr. ordered a FNAC from right cervical lymph node.
I am not sure if the reports are suggestive of a possible lymph-node TB. I don't have anyother symptoms like fever, rash, night sweats, weight reduction etc related to the usual symptoms.
I am attaching the reports alongwith this for your perview. Kindly go through them as I am looking for a second opinion about the course of the treatment that has been suggested.
The dr. also informed me the duration of treatment is for about 6 months but has given the current medicine for 15 days to analyze the treatment/side affects.
Is this really TB that is existent in lymph nodes? I am not sure if the report of the FNAC test co-relates with TB.
As XXXXXXX is really known for having too many wrong diagnosed cases and I don't want to be one of those.
Please review and let me know your suggestion. I am very much confused as after taking the TB medicine for a couple of weeks, the enlarged lymph node hasn't subsided. Is it really TB or something else that needs to be investigated.
Also, I have completed two wks treatment and my liver (SGPT and SGOT) along with Uric acid levels have risen significantly. Attaching the reports for your reference
Brief Answer:
further evaluation needed...
Detailed Answer:
Hello XXXXXXX
Welcome to 'Ask A Doctor' service...
I've gone through your query in details...
I can understand your concerns...
I've gone through all the attached reports here...
First of all, please note that TB pattern and presentations are largely individualized, means not everyone tends to have those classical symptoms which you've already enlisted...
Well, the FNAC report couldn't pinpoint the diagnosis as TB, hence there should've been further evaluation to confirm the diagnosis namely a TB Culture and sensitivity analysis from the aspirate, along with ADA and Gene Xpert study. If still inconclusive, then Lymph node biopsy should be performed (even if its something else, it'll be clearly shown there).
Yes, the duration of treatment can be quite prolonged and should be of a minimum of 6months. It's just been two weeks, it may take several weeks or even more to show some visible effect in the size of the lymph nodes.
Now, coming to the present reports, the SGOT level is not clinically significant however the SGPT and uric acid levels are. So, first of all, you should inform this reports to your doctor, since the treatment with antitubercular drugs already started, careful and more frequent liver function monitoring should be initiated. Along with this, you may be put on anti-oxidants which can be hepatoprotective (eg. N-Acetyl Cysteine or Sylimarin).
Additionally, drink plenty of water throughout the day (at least 2.5-3liter), alcohol should be avoided completely (if at all do)...Do not stop/modify any medications on your own, but always discuss with the treating doctor first.
Ideally, this (including the next step of management which I've briefly outlined above) should be handled in person by an Infectious disease specialist, so, do ask for a referral from your doctor, if possible and proceed without any further delay.
Let me know if I can assist you further...
Wish you a good health...
Take Care
Kind Regards
further evaluation needed...
Detailed Answer:
Hello XXXXXXX
Welcome to 'Ask A Doctor' service...
I've gone through your query in details...
I can understand your concerns...
I've gone through all the attached reports here...
First of all, please note that TB pattern and presentations are largely individualized, means not everyone tends to have those classical symptoms which you've already enlisted...
Well, the FNAC report couldn't pinpoint the diagnosis as TB, hence there should've been further evaluation to confirm the diagnosis namely a TB Culture and sensitivity analysis from the aspirate, along with ADA and Gene Xpert study. If still inconclusive, then Lymph node biopsy should be performed (even if its something else, it'll be clearly shown there).
Yes, the duration of treatment can be quite prolonged and should be of a minimum of 6months. It's just been two weeks, it may take several weeks or even more to show some visible effect in the size of the lymph nodes.
Now, coming to the present reports, the SGOT level is not clinically significant however the SGPT and uric acid levels are. So, first of all, you should inform this reports to your doctor, since the treatment with antitubercular drugs already started, careful and more frequent liver function monitoring should be initiated. Along with this, you may be put on anti-oxidants which can be hepatoprotective (eg. N-Acetyl Cysteine or Sylimarin).
Additionally, drink plenty of water throughout the day (at least 2.5-3liter), alcohol should be avoided completely (if at all do)...Do not stop/modify any medications on your own, but always discuss with the treating doctor first.
Ideally, this (including the next step of management which I've briefly outlined above) should be handled in person by an Infectious disease specialist, so, do ask for a referral from your doctor, if possible and proceed without any further delay.
Let me know if I can assist you further...
Wish you a good health...
Take Care
Kind Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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