Scrofula

Scrofula is most often caused by the bacteria Mycobacterium tuberculosis. There are many other types of mycobacterium bacteria that 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 of scrofula are:

• Fevers (rare)
• Painless swelling of lymph nodes in the neck and other areas of the body
• Sores (rare)
• Sweating

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)
• PPD test (also called TB test)
• Other tests for tuberculosis (TB) including blood tests to detect if you have been exposed to TB

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.

With treatment, people often make a complete recovery.

These complications may occur from this infection:

• Draining sore in the neck
• Scarring

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.

People who have been exposed to someone with tuberculosis of the lungs should have a PPD test.

Tuberculous adenitis; Tuberculous cervical lymphadenitis; TB - scrofula

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. Non-neoplastic lesions of the neck. In: Wenig BM, ed. Atlas of Head and Neck Pathology. 3rd ed. Philadelphia, PA: Elsevier; 2016:chap 12.

Updated by: Jatin M. Vyas, MD, PhD, Associate 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.