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What Is a Scrofula?

Medically Reviewed by Melinda Ratini, DO, MS on June 08, 2021

Scrofula, also called cervical tuberculous lymphadenitis, is a type of tuberculosis infection. It's caused by the same bacteria that causes pulmonary tuberculosis (TB). Tuberculosis is a highly infectious bacterial illness. It usually affects the lungs and can lead to significant lung damage or death if not treated. With scrofula, the bacteria settle in the lymph nodes in your neck instead of infecting your lungs.‌

Scrofula is less common than tuberculosis in the lungs. Only about 5% of tuberculosis cases develop into scrofula. It's relatively rare in the U.S. but there are more cases in areas where tuberculosis is more common. It can be treated with antibiotics.‌‌

In some cases, scrofula is caused by atypical and nontuberculous mycobacteria. This is more common in children than adults. Surgery is often the best treatment for this type of scrofula.

Symptoms of Scrofula

The main symptom is swollen spots in your neck due to the infection in your lymph nodes. The infected lymph nodes will become inflamed, though they're not usually painful. The infection will usually be on one side of your neck.

The swelling may keep increasing and may drain fluid. It can affect your sinuses and the inside of your mouth. In severe cases, you may develop large open sores on your face and neck.

In addition to the characteristic swollen nodes, you may have other symptoms, including:‌

Who Is at Risk for Scrofula?

Your risk of scrofula depends on your health and your exposure to tuberculosis bacteria. ‌

Environment. The risk of contracting scrofula is greater in areas with high tuberculosis transmission. Developing countries tend to have more cases of pulmonary tuberculosis infections and more scrofula cases. The bacteria causing tuberculosis and scrofula pass from person to person. You can also get it from drinking unpasteurized milk that has been contaminated with the bacteria.‌‌

Reactivated tuberculosis. Cases of scrofula in the U.S. are often linked to latent tuberculosis. This is when you're exposed to tuberculosis and the bacteria stays in your body for years, but you may not get sick. Some people never develop symptoms because their immune systems keep the bacteria from multiplying.

Latent tuberculosis bacteria can become active at any time. If that happens, you will show symptoms of tuberculosis disease or scrofula within a few weeks.‌

Immune disorders. People with weaker immune systems are more susceptible to scrofula. If you have scrofula, your doctor may also test you for HIV. People who are HIV positive tend to be more prone to scrofula.

Diagnosing Scrofula

Scrofula can be challenging to diagnose. With pulmonary tuberculosis, breathing problems, pain, and coughing up blood are hard to miss. With scrofula, the symptoms are similar to other illnesses, so doctors may not think to test for the tuberculosis bacteria right away.

Your doctor will examine you and ask questions about your medical history. They may do tests to rule out other conditions that cause lymph nodes to swell, such as cancer or a thyroid condition. They might do blood tests or imaging tests such as X-rays.  ‌

One standard test for tuberculosis is a purified protein derivative test (PPD skin test). Your doctor will inject a small amount of protein from the bacteria under your skin. If the injection site swells or becomes red, that's a signal the bacteria is present in your body. It takes several days for your doctor to be able to determine the results. ‌

Another testing option is to look at fluid from the swollen nodes under a microscope. Your doctor will use a fine needle to draw out a sample of fluid. They'll analyze it to see if there are tuberculosis bacteria in the fluid. 

Treatment for Scrofula

In the Middle Ages, people thought that a touch from the king or queen would cure scrofula. It was called "the king's evil," and the royal touch was the preferred treatment until the 1700s. Now, we have better treatments for bacterial illnesses.‌

Antibiotics. Scrofula, like pulmonary tuberculosis, can be treated with antibiotics. Your doctor will prescribe a combination of drugs that will stop the infection. This is a long-term treatment. You will need to take the medications for 6 to 9 months. If you have HIV or another immune system disorder, you may need a longer course of antibiotics.

Surgery. In some cases, doctors can remove the affected lymph nodes. This requires surgery, and is not always effective. It works best in cases where scrofula is caused by nontuberculous bacteria.

If you suspect you have scrofula, you should speak to a doctor right away. You will need medical treatment to cure the infection. 

WebMD Medical Reference

Sources

SOURCES: 

Bhandari J, Thada PK. Scrofula, StatPearls Publishing, 2021

Canadian Medical Association Journal: "Scrofula, the king's evil."

Centers for Disease Control and Prevention: "TB Signs & Symptoms," "Treatment for TB Disease."

International Journal of Emergency Medicine: "Scrofula: emergency department presentation and characteristics."

Pahal P, Sharma S. PPD Skin Test. StatPearls Publishing, 2021.

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