Scrofula — the dangerous masquerader

Mycobacterial cervical lymphadenitis or scrofula continues to puzzle the clinician. Its propensity for mimicking other diseases delays treatment and increases the risk to the general public and hospital personnel. Historical data, physical findings and laboratory tests are often unreliable, thus delaying diagnosis and treatment. Sixteen patients with scrofula were treated from 1975 to 1980. Most patients were from India, Pakistan, or Latin‐America. Only 3/16 gave a positive history of TB contact, 6/16 had constitutional symptoms, 8/16 had matted nodes, 9/16 had nodes in the posterior triangle, and only 1/16 had a positive chest x‐ray. AFB stain was negative in 9/16 patients; culture was negative in 8/16. Skin testing and histologic analysis were more reliable, with 13/16 and 13/14 positive respectively. Our experience confirms both the importance of attempting excisional biopsy, where feasible, and the increased morbidity associated with incisional biopsy in the scrofula patient. All patients in our series responded well to treatment with combination standard antitubercular medications including isoniazid, ethambutol, pyridoxine and rifampin.