Scrofula
Scrofula, is also known by a variety of combinations of tuberculosis, cervical and lymphadenitis, and comes from the Latin for 'brood sow' - exactly why is unclear to me. It is also known as King's evil as in the Middle Ages it was believed that "royal touch", the touch of the sovereign of England or France, could cure the disease. It is unlikely that this was the case.
It is a manifestation of extra pulmonary tuberculosis and is a very frequent cause of peripheral lymphadenitis in the developing world. There is recognised resurgence in the developed world among the immunocompromised population.
The aetiology is thought most likely to represent postprimary reactivation of Mycobacterium tuberculosis spread haematogenously. It is also thought that it may be infection via the tonsils, in a similar fashion to gastrointestinal tuberculosis from infected milk.
Treatment is with antimycobacterial agents, as drainage, percutanous or surgical does not work well and is liable to create fistulae, which can also occur spontaneously.
Differential diagnoses
Lymph nodes with low density are typically seen with:
- fungal infection
- pyogenic infection
- necrotic metastases (esp. SCC, and papillary thyroid cancer)
- lymphoma : only occasionally, more so after treatment
- Kimura disease
