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Scrofula

Condition Overview:

Alternate Names : Tuberculous Adenitis

Scrofula is a tuberculous infection of the skin of the neck, most often caused by mycobacteria (including Mycobacteriumtuberculosis), in adults. In children, it is usually caused by Mycobacterium scrofulaceum or Mycobacterium avium.

Infection with mycobacteria is usually caused by inhaling air contaminated by these organisms. The bacteria spread throughout the body, and may cause rubbery enlargement of the lymph nodes in the neck (cervical lymph nodes) as well as elsewhere. If these are not treated, the lymph nodes may become ulcerated, producing draining sores.

The most usual signs and symptoms are the appearance of a chronic, painless mass in the neck, which is persistent and usually grows with time. The mass is referred to as a "cold abscess", because there is no accompanying local calor or warmth and the overlying skin acquires a violaceous color. NTM infections do not show other notable constitutional symptoms, but scrofula caused by tuberculosis is usually accompanied by other symptoms of the disease, such as fever, chills, malaise and weight loss in ca. 43% of the patients. As the lesion progresses, skin becomes adhered to the mass and may rupture, forming a sinus and an open wound.

Diagnosis is usually performed by needle aspiration biopsy or excisional biopsy of the mass and the histological demonstration of stainable acid-fast bacteria in the case of infection by M. tuberculosis (Ziehl-Neelsen stain), or the culture of NTM using specific growth and staining techniques.