Scrofula (Scrophula or Struma) refers to a variety of skin diseases; in particular, a form of tuberculosis, affecting the lymph nodes of the neck. In adults it is caused by Mycobacterium tuberculosis and in children by nontuberculous mycobacteria. The word comes from the Latin scrofulae, meaning brood sow.
Scrofula is the term used for tuberculosis of the neck, or, more precisely, a cervical tuberculous lymphadenopathy. Scrofula is usually a result of an infection in the lymph nodes, known as lymphadenitis and is most often observed in immunocompromised patients (ca. 50% of cervical tuberculous lymphadenopaty). In ca. 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis, but only 8% in children. The rest are caused by atypical mycobacterium or nontuberculous mycobacterium (NTM). With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a very rare disease. With the appearance of AIDS, however, it has shown a resurgence, and presently affects ca. 5% of severely immunocompromised patients.
Signs and symptoms
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 (bluish-purple) 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
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.
Therapy
Treatment approaches are highly dependent on the kind of infection. Surgical excision of the scrofula does not work well for M. tuberculosis infections, and has a high rate of recurrence and formation of fistulae. Furthermore, surgery may spread the disease to other organs. The best approach then is to use conventional treatment of tuberculosis with antibiotics. Scrofula caused by NTM, on the other hand, responds well to surgery, but is usually resistant to antibiotics. The affected nodes can be removed either by repeated aspiration, curettage or total excision (with the risk in the latter procedure, however, of causing cosmetically negative effects or damage to the facial nerve, or both)
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