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A small gland detected. Biopsy report said cox. What is it? And the treatment?

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General & Family Physician
Practicing since : 2003
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Hi Doctor I am a 44 years old man. I am working as a Accountant. One week before One small gland on the left side detected. I went to surgeon for biopasy after consultation with my family doctor. Biopacy report says its "cox". Kindly explain me what is COX and what will be the line of treatment. How long treatment will be continued.

Posted Mon, 7 May 2012 in General Health
Answered by Dr. Gowri Kulkarni 1 hour later

Thank you for posting in your query.

The "gland" that you speak of must be a Lymph node and what you call as "cox" is most probably "Koch's".

Koch is another term for Tuberculosis (TB).

Tuberculosis is a disease caused by Mycobacteria. It can affect any organ in our body. TB germs are most commonly found in the lungs, but sometimes they can move to other parts of the body. TB germs are passed through the air when a person who is sick with TB disease coughs, sneezes, or laughs.
Following are the symptoms:
Cough (2-3 weeks or more); Coughing up blood; Fever; Night sweats; Feeling weak and tired; Losing weight without trying ; Decreased or no appetite; etc.
If you have TB outside the lungs, you may have other symptoms like infertility, swellings, fractures, etc.

Fortunately Tuberculosis is curable.

The treatment includes what is known as DOTS regimen which involves taking 4 drugs (Isoniazid, Rifampicin, Ethambutol, Pyrizinamide) for 2 months and then 2 drugs (Isoniazid, Rifampicin) for 4 months i.e. total 6 months which is the shortest duration of treatment

Along with this you will have to eat a protein XXXXXXX diet, drink plenty of water and take adequate rest.

The duration of treatment depends on the kind of infection, place of infection and if the bacteria are multi-drug resistant variety.

The earlier you start the treatment the better.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Wishing you a hasty recovery

Dr Gowri
Above answer was peer-reviewed by
Follow-up: A small gland detected. Biopsy report said cox. What is it? And the treatment? 32 hours later
Actually above information which I asked was related to my yunger brother XXXXXXX Your reply was good enough but I have not satisfied with it; therfore I am giving further detail for more clarification.
Kindly note that in my brother biopasy(Dt 17-11-2011) first report (Dt 21-11-2011)impression was "HODGKINS LYMPHOMA OF CERVICAL LYMPH NODE" then with the same slide & block we went for second opinion(Dt 28-11-2011) which says "Necrotising lymphadenitis of Kikuchi-Fujimoto type* ZN stain for acid-fast bacilli is negative and comment is : Every case of KIkuchi-Fujimoto disease must be investigated for non reactive tuberculosisi & collagen vascular disease"
Now doctore says it is not a HODGKINS & even it is not proved as tuberculosis. please guide me in this matter what type treatment to be given, he should be treated as anti koch's or something else or still further any test to be done so that illness will be cleared.
Please guide we are confused and still no treatment is started, but here one thing I would like quote he doesn't have any fever or he has not lost any weight. Healthwise he is perfectly alright.
Hoping to get favourable reply soon.
Answered by Dr. Gowri Kulkarni 46 hours later

Thank you for posting in the query

The causes of this swelling that you mention could be many like Tuberculosis, Atypical mycobacterial infection, Epstein-Barr virus infection, Cytomegalovirus, HIV, Toxoplasmosis, Lymphoma, Kawasaki disease, Kikuchi-Fujimoto disease, SLE

Your brother will need to get evaluated again by a Hematologist

It would be helpful to get the following blood tests to find if there is any associated collagen vascular or autoimmune illness
ANA; anti-dsDNA; anti-Sm; anti-RNP; anti-cardiolipin; Anti Ro, Anti La

You could also get the following tests done to rule out any viral illnesses
Antibodies to Toxoplasma, Epstein barr virus, Cytomegalovirus; VDRL for Syphilis

Baseline Complete Blood Count, Erythrocyte sedimentation rate, C Reactive Protein and Procalcitonin might give us some idea towards the cause

I also suggest that you get another slice biopsy evaluated

You could also get a CT scan to rule out if there are any other similar enlarged glands

With no fever and weight loss it is less likely to be Hodgkin's. As the ZN stain has come negative, the inclination towards tuberculosis is also low

Treatment can begin only after ascertaining the diagnosis

Hope I have answered your query


Dr Gowri

Above answer was peer-reviewed by
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