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Scrofula
Definition
Scrofula is a tuberculous infection of the lymph nodes in the neck.
Alternative Names
Tuberculous adenitis
Causes
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
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
- 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.
Outlook (Prognosis)
With treatment, patients usually make a complete recovery.
Possible Complications
- Draining sore in the neck
- Scarring
When to Contact a Medical Professional
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.
Reviewed By: 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.
