Scrofula
Definition
Scrofula is a tuberculosis infection of the lymph nodes in the neck.
Alternative Names
Tuberculous adenitis; Tuberculous cervical lymphadenitis; TB - scrofula
Causes
Scrofula is most often caused by the bacteria Mycobacterium tuberculosis. There are other types of mycobacterium bacteria that may 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:
- Fever (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 (if positive, treatment would be modified)
- Interferon-gamma release blood test, such as the QFT-Gold test to check for TB infection (active or infection in the past)
- PPD test (also called TB test)
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
Contact 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.
References
Centers for Disease Control and Prevention website. Tuberculosis (TB). www.cdc.gov/tb/index.html. Updated October 30, 2024. Accessed December 22, 2024.
Pasternack MS. Lymphadenitis and lymphangitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 95.
Wenig BM, Hernandez-Prera JC. Nonneoplastic lesions of the neck. In: Wenig BM, Hernandez-Prera JC, eds. Atlas of Head and Neck Pathology. 4th ed. Philadelphia, PA: Elsevier; 2024:chap 12.
Reviewed By: Jatin M. Vyas, MD, PhD, Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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