Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 26, 2011
Scrofula
- Most common in children and becoming more common in HIV/AIDS population. Presents with symptomatology consistent with underlying infection. Evaluation demonstrates lymphadenopathy. Typical chest abnormalities of TB are not often present.
- Lymphadenopathy is painless, and can be present weeks to months before diagnosis is made. Lack of response to typical antibiotics is often what leads to consider this entity.
- Such lymphadenopathy can be caused by either tuberculosis or nontuberculous mycobacterium. The cervical adenopathy has been called "scrofula." Excisional biopsy is preferred over biopsy, for risk of creating a sinus tract.
- Key Diagnostic Features: Necrotic lymphadenopathy
- DDx: Suppurative lymphadenopathy, necrotic metastases, lymphoma
- Rx: Rifampin, isoniazid, ethambutol, and pyrazinamide for several months. Combinations based on Infectious Disease input.
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