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Scrofula

Scrofula is a tuberculous infection of the lymph nodes in the neck.

Alternative Names

Tuberculous adenitis

Causes, incidence, and risk factors

Scrofula in adults is most often caused by the bacteria Mycobacterium tuberculosis. In children, can also be caused by Mycobacterium scrofulaceum or Mycobacterium avium.

Infection with mycobacteria is usually caused by breathing in air that is contaminated by these organisms.

Symptoms

  • Fevers (rare)
  • Painless swelling of lymph nodes in the neck and elsewhere in body
  • Sores (ulceration -- rare)
  • Sweats

Signs 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
  • Other tests for TB

Treatment

When infection is caused by Mycobacterium tuberculosis, treatment usually involves 9 - 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, and clarithromycin.

Surgery is sometimes used first. It may also be used if medications are not working.

Expectations (prognosis)

With treatment, patients usually make a complete recovery.

Complications

  • Draining sore in the neck
  • Scarring

Calling your health care provider

Call your health care provider if 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.

References

Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 332.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 250.

Updated: 10/6/2012

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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