Scrofula is any of a variety of skin diseases; in particular, a form of tuberculosis, affecting the lymph nodes of the neck. It is often informally or historically known as 'King's Evil', referring to the method of treatment many sufferers used, in some cases in England up to the reign of King Charles II. In adults it is caused by Mycobacterium tuberculosis and in children by nontuberculous mycobacteria. The word comes from the Latin scrofula, 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 (about 50% of cervical tuberculous lymphadenopathy). About 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis, but only 8% of cases in children. The rest are caused by atypical mycobacterium (Mycobacterium scrofulaceum) or nontuberculous mycobacterium (NTM).
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 color 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 about 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 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.
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