Scrofula

What is scrofula?

Scrofula is a swelling of the lymph nodes in your neck caused by a bacterial infection. It can cause a large, matted mass on your neck from several lymph nodes fusing together. It’s usually painless or only slightly tender. It can be discolored, purplish or the same color as your skin.

Scrofula is usually a form of tuberculosis. It used to be called “king’s evil” because people thought the king could heal diseases. Now healthcare professionals call scrofula “mycobacterial cervical lymphadenitis.”

How common is scrofula?

Scrofula is pretty rare. Only about 5% of symptomatic tuberculosis cases are diagnosed as scrofula.

What are the symptoms of scrofula?

Most people with scrofula only have enlarged cervical (neck) lymph nodes. Some people with scrofula also have additional symptoms of a bacterial infection, including:

• Fever.
• Night sweats.
• Unintended weight loss.
• Fatigue.

What causes scrofula?

Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB), causes most cases of scrofula in adults. You get it when you breathe the bacteria into your lungs and it travels to the lymph nodes of your neck.

Other kinds of Mycobacterium infections cause scrofula in kids.

What are the risk factors for scrofula?

Living with HIV is the most common risk factor for scrofula. Malnutrition and other conditions that weaken your immune system (like immunosuppressive medications, some autoimmune conditions and certain cancers) can also put you at risk.

What are the complications of scrofula?

Sometimes the swelling caused by scrofula can open up and leak fluid. This might cause a sinus, or a tunneling hole, in your skin. The wound can lead to scarring.

How is scrofula diagnosed?

Since many things can cause enlarged lymph nodes, your provider might perform or recommend many tests to get a scrofula diagnosis. These include:

• Biopsy. A provider will either remove a lymph node or use a needle to take a sample of tissue to try to grow (culture) and look for (stain for) mycobacteria.
• Blood tests. Your provider can look for mycobacteria and other infections with a blood sample.
• Imaging. Your provider might get a chest X-ray, CT scan or ultrasound to get images of your lungs or your neck.
• Tuberculosis tests. Skin (PPD) or blood tests can indicate if you have TB.
• Acid-fast bacilli test. A provider can use a tissue sample or a sample of mucus coughed up from your lungs to look for mycobacteria.

How is scrofula treated?

Providers treat scrofula with specific antibiotic medications (like macrolides) for mycobacterial infections. You usually have to take the medication for several months to a year. Antibiotic medications that can treat mycobacterial infections include:

• Ethambutol.
• Isoniazid (INH).
• Pyrazinamide.
• Rifampin.
• Clarithromycin.

Your provider may also surgically remove your affected lymph nodes.

Can you prevent scrofula?

You can lower your risk of scrofula by getting tested for a latent TB infection. Latent TB doesn’t cause symptoms but can spread to other areas of your body, causing infections like scrofula. If you find out you have a TB infection, you can treat it before it spreads.

You can also be vaccinated for TB with the Bacillus Calmette-Guérin (BCG) vaccination. BCG is only available in areas where TB is common. It’s not available in the U.S.

What can I expect if I have scrofula?

You can make a full recovery from scrofula with treatment. But you need to make sure you take all of your medication as directed by your provider, and for the entire course of treatment. You usually have to take medication for several months to a year. Wound scarring might be permanent.

Your provider may recommend directly observed therapy (DOT). This is where someone (not a family member) provides your medication and stays with you while you take them. Then you don’t have to worry about forgetting doses.

Is scrofula fatal?

Scrofula is rarely fatal if treated, but it can be difficult to know the exact mortality (death) rate. Mortality studies usually focus on mycobacterial infections in your lungs, which could have a much different outcome.

How do I take care of myself?

The best way to take care of yourself is to keep in close contact with your healthcare provider and make sure you’re taking your medications as directed. You can prevent the spread of bacteria by avoiding contact with others while you have TB or nontuberculous mycobacteria.

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• How do I take my medication?
• What do I do if I miss a dose?
• How long will I need to be on treatment?
• How long will it take for me to feel better?
• What new or worsening symptoms should I look out for?
• When should I follow up with you?

A note from Cleveland Clinic

Scrofula is rare and usually curable. Treatment can take a long time — you might have to be patient while you heal. Follow up with your healthcare provider frequently, especially if you have another underlying illness, like HIV. Your provider can help you monitor your progress, adjust your medication if needed, and address any concerns along the way.