What Is Scrofula and How Is It Managed?

Written by Medicover Team and Medically Reviewed by Dr Vamsi Krishna Kedarisetti , General Medicine

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Scrofula, also known as tuberculous cervical lymphadenitis, is a form of lymph node infection that most commonly affects the lymph nodes in the neck. It is usually caused by Mycobacterium tuberculosis, although non-tuberculous mycobacteria can also be responsible, especially in children. Early diagnosis and appropriate treatment help prevent complications such as abscess formation, scarring, and the spread of infection.

What Are the Types of Scrofula?

Scrofula can be classified based on the organism causing the infection.

Tuberculous Scrofula: Caused by Mycobacterium tuberculosis and often associated with pulmonary or extrapulmonary tuberculosis.
Non-Tuberculous Mycobacterial (NTM) Scrofula: Caused by environmental mycobacteria, most commonly affecting children with otherwise healthy immune systems.

What Are the Symptoms of Scrofula?

Symptoms usually develop gradually and mainly involve the lymph nodes of the neck.

Painless swelling of neck lymph nodes
Gradually enlarging lymph nodes
Redness of the overlying skin
Formation of abscesses
Draining sinus or ulcer over the affected node
Fever
Night sweats
Weight loss
Fatigue

What Causes Scrofula?

Scrofula develops when mycobacterial organisms infect the cervical lymph nodes.

Mycobacterium tuberculosis infection
Non-tuberculous mycobacterial infections
Spread of tuberculosis from another part of the body
Weakened immune system
Environmental exposure to mycobacteria

When Should You See a Doctor for Scrofula?

Scrofula is usually treated by an infectious disease specialist or a pulmonologist. Depending on the underlying cause and complications, care may also involve an ENT specialist, a general surgeon, a pathologist, and a radiologist for a comprehensive diagnosis and treatment.

Seek medical attention if you experience:

Persistent swollen lymph nodes lasting more than two weeks
Neck swelling that continues to increase in size
Pus discharge or ulcers over swollen lymph nodes
Fever, night sweats, or unexplained weight loss
Known exposure to tuberculosis
Persistent neck lumps despite antibiotic treatment

Early diagnosis and treatment help prevent complications and reduce the spread of tuberculosis.

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How Is Scrofula Diagnosed?

Diagnosis combines clinical examination, laboratory investigations, imaging, and tissue sampling to identify the underlying infection.

Medical history and physical examination
Tuberculin skin test (TST)
Interferon-Gamma Release Assay (IGRA)
Blood investigations
Fine-needle aspiration cytology (FNAC)
Lymph node biopsy
Mycobacterial culture and PCR testing
Ultrasound of the neck
CT scan when needed
Chest X-ray to evaluate pulmonary tuberculosis

How Is Scrofula Treated?

Treatment depends on whether the infection is caused by tuberculosis or non-tuberculous mycobacteria. The primary goal is to eliminate the infection, prevent complications, and preserve normal lymph node function.

Anti-tuberculosis medications: A combination of isoniazid, rifampicin, pyrazinamide, and ethambutol for tuberculous scrofula.
Antibiotics for NTM infection: Macrolides, ethambutol, rifamycins, or other antibiotics based on culture results.
Surgical drainage: Performed for large abscesses or persistent collections.
Lymph node excision: May be recommended for selected non-tuberculous infections or recurrent disease.
Supportive care: Adequate nutrition, hydration, and monitoring during treatment.

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What Are the Risk Factors for Scrofula?

Certain individuals are more likely to develop scrofula because of infection exposure or reduced immunity.

Exposure to tuberculosis
Living in areas with high tuberculosis prevalence
HIV infection or other immunodeficiency disorders
Immunosuppressive medications
Childhood (for non-tuberculous mycobacterial infections)
Malnutrition
Close contact with infected individuals

What Complications Can Scrofula Cause?

Untreated scrofula can lead to both local and systemic complications.

Abscess formation
Skin ulceration
Fistula formation
Permanent neck scarring
Spread of tuberculosis to other organs
Recurrence of infection

Can Scrofula Be Prevented?

Although not all cases are preventable, the risk can be reduced by early diagnosis and treatment of tuberculosis, receiving the BCG vaccine where recommended, maintaining good hygiene, avoiding close contact with individuals with active tuberculosis, strengthening the immune system through proper nutrition, and attending regular medical check-ups if you are at high risk.

What Is the Prognosis for Scrofula?

Most patients recover well with timely diagnosis and appropriate antimicrobial treatment. Early medical care significantly reduces the risk of complications, prevents permanent scarring, and limits the spread of tuberculosis. Completing the full treatment course and attending follow-up appointments are essential for successful recovery.

Frequently Asked Questions

1. What are the symptoms of scrofula?

Symptoms typically include painless, swollen lymph nodes in the neck that may gradually enlarge. Other symptoms can include fever, night sweats, weight loss, fatigue, and, in some cases, draining sores if the affected lymph nodes rupture.

2. What causes scrofula?

Scrofula is most commonly caused by Mycobacterium tuberculosis, the bacterium that causes tuberculosis. It can also be caused by nontuberculous mycobacteria (NTM), particularly in children.

3. How is scrofula diagnosed?

Diagnosis involves a physical examination, imaging studies such as ultrasound or CT scans, and testing of lymph node tissue or fluid using biopsy, culture, microscopy, and molecular tests to identify the causative organism.

4. What treatment options are available for scrofula?

Treatment depends on the cause. Tuberculous scrofula is treated with a combination of anti-tuberculosis medications for several months. Nontuberculous mycobacterial infections may require surgery, antibiotics, or both.

5. What are the risk factors for scrofula?

Risk factors include exposure to tuberculosis, weakened immune function (such as HIV infection), close contact with infected individuals, living in areas where tuberculosis is common, malnutrition, and, for nontuberculous mycobacterial infections, young age and environmental exposure to mycobacteria.