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PubMedDate not supplied

Diagnostic problems of tuberculous cervical adenitis (scrofula).

PURPOSE: This study was designed to review the diagnostic procedure for tuberculous cervical adenitis and propose a simple protocol for the work-up of patients with suspected tuberculous cervical adenitis. Moreover, it served to increase physician awareness of tuberculosis as possible cause of cervical mass. PATIENTS AND METHODS: We performed a retrospective study of 57 patients with tuberculous cervical adenitis who were treated at North West Armed Forces Hospital, Tabuk, Saudi Arabia between March 1989 and April 1993. The results of diagnostic procedures, chest x-ray, tuberculin test, fine-needle aspiration, microbiology culture, and histopathology were reviewed. RESULTS: Forteen percent showed changes in chest x-ray, 92% had positive tuberculin test, and 50% of the culture material grew Mycobacterium tuberculosis. All specimens for histopathology were suggestive of tuberculosis. CONCLUSION: A thorough history and physical examination, tuberculin test, and fine-needle aspiration will help arrive at an early diagnosis of tuberculous cervical adenitis and allow early commencement of treatment before final diagnosis can be made by incisional biopsy and culture. Tuberculosis should be included in the differential diagnosis of neck mass.

Adolescent↗
PubMed2002

Erythema nodosum associated with reactivation tuberculous lymphadenitis (scrofula).

A 73-year-old African American female presented to our clinic with painful lower extremity lesions of 2 weeks duration. She was in her usual state of health until 3 months prior to presentation when she reported symptoms of fatigue and weakness. She also noticed an enlarging mass on the left side of her neck. She denied fevers, chills, night sweats or cough. Her symptoms were unresponsive to a course of oral dicloxacillin. The neck mass enlarged over 8 weeks and she was referred to our institution for evaluation. CT scan of the neck showed an enlarged lymph node. Ten days prior to her presentation in dermatology, a fine needle aspirate of the enlarging lymph node revealed necrotizing granulomas. Tissue was sent for routine mycobacterial and fungal cultures. Routine blood work, chest radiograph, and a tuberculin skin test were also performed. At the time of her dermatology visit she described the development of multiple new painful, non-pruritic lesions, bilaterally on the lower extremities. She also reported a red crusted area that appeared at the site of her tuberculin test that was placed subsequent to the development of her lower extremity lesions. Her past medical history was significant for Parkinson's disease, hypothyroidism and hypertension. Her current medications included l-thyroxine, estrogen and diltiazem. Her travel history was only remarkable for a trip to Jamaica the previous spring. She was born and raised in Haiti. She reported a history of a positive tuberculin skin test 20 years ago, but received no therapy. Physical examination revealed a 2 x 3 centimeter firm, nontender left lateral neck mass (Fig. 1). Her right forearm revealed an erythematous, ulcerated, indurated plaque 1.5 cm in diameter (Fig. 2.). Her lower extremities revealed tender 0.5 to 1 cm erythematous nodules below the knees bilaterally (Fig. 3). A punch biopsy of a lower extremity nodule revealed a mild pervisacular dermal infiltrate. Within the subcutaneous tissue there was septal widening. There was also a lymphohistiocytic infiltrate with a slight admixture of neutrophils within the septa of the fat lobules. There was no evidence of necrotizing vasculitis or collagen necrosis. An acid-fast stain was not performed. The histologic findings were consistent with a diagnosis of erythema nodosum. Her laboratory evaluation including CBC, electrolytes, thyroid studies, angiotensin converting enzyme level and chest radiograph were normal. Approximately 1 week after her dermatological evaluation, the fine-needle aspirate culture grew Mycobacterium tuberculosis. A diagnosis of tuberculous lymphadenitis associated with erythema nodosum was confirmed. The patient was started on quadruple therapy of isoniazid, rifampin, ethambutol and pyrazinamide. Her lower limb skins lesions rapidly resolved over the subsequent month and her neck mass also diminished in size. She completed 6 months of antituberculous therapy with complete resolution of her lymphadenopathy.

Aged↗
PubMedDate not supplied

Scrofula.

Explore the source record for details and available documents.

Adult↗
PubMed2000

Scrofula revisited: an update on the diagnosis and management of tuberculosis of superficial lymph nodes.

Lymph node tuberculosis is a disease of great antiquity. It is the commonest form of extra-pulmonary tuberculosis, and is probably the commonest cause of chronic lymphadenitis in children. Even after the advent of effective chemotherapy for tuberculosis, it still poses considerable problems in diagnosis and management. The disease usually presents as a painless lymphadenopathy of the superficial lymph nodes of insidious onset, which may proceed to abscess and sinus formation if neglected. Cervical nodes are most commonly affected, but multiple node involvement is common. Differential diagnosis include other infections, neoplasia, congenital conditions in the head and neck and rarely, drug reactions. Diagnosis, whenever feasible, should be made on the basis of histological evidence after lymph node biopsy. Diagnosis made on clinical grounds has poor specificity and will result in a great degree of over diagnosis. Recently, the role of fine needle aspiration cytology as an initial screening procedure has been recognized. The Tuberculosis Research Centre carried out the first clinical trial which established the efficacy of short course chemotherapy in the treatment of childhood lymph node tuberculosis. In 168 children with biopsy confirmed lymph node tuberculosis treated with an intermittent six month regimen, the cure rate after five years was 95%. The Revised National Tuberculosis Control Programme recommends that patients with lymph node tuberculosis (Category 3) should be treated with rifampicin and isoniazid three times a week for six months, with pyrazinamide for the first two months.

Antitubercular Agents↗