I have painful cervical lymph nodes. My blood ESR is 85. My doctor has recommended ATT. However, I had a similar problem when I was 14 and upon taking ATT, the drug reacted and I went into Stevenson Johnson syndrome and was administerd steroids to come out of it. The nodes dis

Question (Posted on : 12 Oct 2008 )

I have painful cervical lymph nodes. My blood ESR is 85. My doctor has recommended ATT. However, I had a similar problem when I was 14 and upon taking ATT, the drug reacted and I went into Stevenson Johnson syndrome and was administerd steroids to come out of it. The nodes disappeared and the Doctors said I did not have TB at all. Please advise

Doctor's Response (Posted on : 12 Oct 2008 )

Multiple cervical lymph nodes with such a markedly raised ESR (normal for Indian women being less than 20 mm/hour) strongly suggest the possibility of tuberculous adenitis. A simple slightly invasive investigation, namely, FNAC of the node (fine needle aspiration cytology) would help in arriving at the correct diagnosis; your Mantoux test would also be strongly positive (more than 15mm in diameter). X-ray chest PA veiw / CT scan chest would be of additional help to detect the presence of such enlarged nodes inside the chest (around the hila and tracheal carina).If it proves to be of tuberculous aetiology, it is mandatory that you take the full course of anti-tubeculous therapy. We usually treat any form of tuberculosis with 4-drug regimen for the first 2 to 3 months followed by 2-drug regimen extending for another 6 to 7 months. You seem to have developed a severe form of drug allergy, known as 'erythema multiforma bullosum' (Stevens-Johnson syndrome) on an earlier occasion to one of the four drugs. Nowadays, serological and haematological tests are available to determine to which drug you are allergic and your doctor would plan a management without using the offending drug. Such tests include RAST (radio allergo sorbent test) and basophil degranulation test of Shelley. Speicalists in allergy would help us in this regard.The fact that your gland had disappeared after a course of steroid therapy does not necessariy mean that it was not tuberculoisis; steroids have the effect of interfering with normal inflammatory response of our body and hence the gland would have temporarilly disappeared. If in doubt, you may go in for 'excision biopsy' of one of the lymph nodes to finalise the diagnosis once and for all. Kindly inform the fact that you had developed severe reaction to your treating consultant so that he would be cautious in formulating the most appropriate therapeutic plan for you. It is possible to treat your nodes without using the offending drug (alternative and equally effective drugs are available in the market)

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