Advanced Practice: A Cold Abscess?

  • Scrofula is cervical lymphadenitis due to tuberculosis. 
  • Lymphadenitis is the most common extrapulmonary manifestation of TB, more often in patients with HIV, which is why it is always important to assess for HIV infection in patients with scrofula.
  • Tuberculosis lymphadenitis is frequently referred to as a “cold abscess” as it often lacks the typical warmth, erythema and tenderness seen with abscesses. 
  •  Fine-needle aspiration can confirm the diagnosis, which will show acid-fast bacilli
  • Medical treatment should be trialed first with isoniazid, rifampin, pyrazinamide, and ethambutol. If medical therapy fails, surgical excision may be utilized, although a high rate of reoccurrence and complications exist

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eChapter 67: Tuberculosis. Vu D. Phan; Janet M. Poponick.