Scrofula

Alternative names: Tuberculous adenitis; Tuberculous cervical lymphadenitis; TB — scrofula

Definition: Scrofula is a tuberculosis infection of the lymph nodes in the neck.

Causes

Scrofula is most often caused by the bacteria Mycobacterium tuberculosis. There are many other types of mycobacterium bacteria that cause scrofula.

Scrofula is usually caused by breathing in air that is contaminated with mycobacterium bacteria. The bacteria then travel from the lungs to lymph nodes in the neck.

Symptoms

Symptoms of scrofula are:

Fevers (rare)
Painless swelling of lymph nodes in the neck and other areas of the body
Sores (rare)
Sweating

Exams and Tests

Tests to diagnose scrofula include:

Biopsy of affected tissue
Chest x-rays
CT scan of the neck
Cultures to check for the bacteria in tissue samples taken from the lymph nodes
HIV blood test
PPD test (also called TB test)
Other tests for tuberculosis (TB) including blood tests to detect if you have been exposed to TB

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Treatment

When infection is caused by Mycobacterium tuberculosis, treatment usually involves 9 to 12 months of antibiotics. Several antibiotics need to be used at once. Common antibiotics for scrofula include:

Ethambutol
Isoniazid (INH)
Pyrazinamide
Rifampin

When infection is caused by another type of mycobacteria (which often occurs in children), treatment usually involves antibiotics such as:

Rifampin
Ethambutol
Clarithromycin

Surgery is sometimes used first. It may also be done if the medicines are not working.

Outlook (Prognosis)

With treatment, people often make a complete recovery.

Possible Complications

These complications may occur from this infection:

Draining sore in the neck
Scarring

When to Contact a Medical Professional

Call your health care provider if you or your child has a swelling or group of swellings in the neck. Scrofula can occur in children who have not been exposed to someone with tuberculosis.

Prevention

People who have been exposed to someone with tuberculosis of the lungs should have a PPD test.

ReferencesPasternack MS, Swartz MN. Lymphadenitis and lymphangitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 97.

Wenig BM. Non-neoplastic lesions of the neck. In: Wenig BM, ed. Atlas of Head and Neck Pathology. 3rd ed. Philadelphia, PA: Elsevier; 2016:chap 12.

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