Tuberculosis of cervical lymph nodes (also known as scrofula) is most commonly observed in children and young adults. It is often caused by Mycobacterium tuberculosis spreading through the tonsils or dental caries and is secondary to pulmonary or bronchial tuberculosis in approximately 5% of cases.
Clinical Manifestations
There may be the presence of multiple enlarged lymph nodes of varying sizes on one or both sides of the neck, typically located along the anterior or posterior border of the sternocleidomastoid muscle. In the early stages, the enlarged lymph nodes are firm, painless, and movable. As the disease progresses, perilymphadenitis may develop, causing the lymph nodes to adhere to the skin and surrounding tissues. Lymph nodes may also fuse together, forming immobile nodular masses.
With further progression, the lymph nodes may undergo caseous necrosis and liquefaction, leading to the formation of a cold abscess. If the abscess ruptures, it may result in a sinus tract or chronic ulceration that persists without healing. Different stages of these pathological changes can simultaneously occur in different lymph nodes of the same patient.
Some patients may also experience systemic symptoms such as low-grade fever, night sweats, loss of appetite, and weight loss.
Diagnosis
The diagnosis is often established based on a history of exposure to tuberculosis and local clinical signs, particularly when a cold abscess has formed or a sinus tract or chronic ulcer persists. If differentiation between conditions proves difficult, fine-needle aspiration or excisional biopsy of one or more lymph nodes may be performed for pathological examination.
Treatment
Systemic Treatment
Nutritional support and adequate rest are essential. Oral isoniazid should be administered for 6–12 months. Patients with systemic symptoms or tuberculosis in other parts of the body should receive standard anti-tuberculosis therapy.
Local Treatment
For a limited number of enlarged, movable lymph nodes of significant size, surgical excision may be considered, taking care to avoid injury to the accessory nerve during the procedure.
In cases where a cold abscess has not yet ruptured, fine-needle aspiration may be performed. The needle should be inserted through normal skin surrounding the abscess, and as much pus as possible should be aspirated. Afterward, the cavity may be irrigated with a 5% isoniazid solution, leaving a small amount within the cavity. This procedure is typically repeated twice weekly.
For ulcers or sinus tracts without significant secondary infection, curettage may be performed. The wound should remain open for drainage and is not sutured.
In cases of secondary pyogenic infection of cold abscesses, incision and drainage are necessary to control the infection, after which curettage may be performed if needed.