Scrofula as a presentation of tuberculosis and HIV

Headnote

ABSTRACT

Scrofula, or tuberculous cervical lymphadenitis, though now rare, is more commonly seen in minorities, women and immunosuppressed patients, especially those with HIV. We discuss a patient who presented to the emergency department with an anterior neck abscess and was diagnosed with both advanced HIV and disseminated tuberculosis. A high level of suspicion is necessary to make this diagnosis, but given an increasing degree of global mobility, such patients may present anywhere. Medical management is effective, though difficult. Early diagnosis improves the patient's individual prognosis and may prevent further exposure and transmission to the population.

RÉSUMÉ

Même si elle est rare de nos jours, la scrofule ou lymphadénite cervicale tuberculeuse se manifeste plus souvent chez les minorités, chez les femmes et chez les patients immunodéprimés, et en particulier ceux qui sont infectés par le VIH. Nous décrivons le cas d'un patient qui s'est présenté à l'urgence avec un abcès à la partie antérieure du cou et chez lequel on a diagnostiqué à la fois une infection avancée au VIH et une tuberculose miliaire. Il faut avoir de solides raisons de soupçonner cette maladie pour poser un tel diagnostic, mais compte tenu de la mobilité mondiale croissante, ces patients peuvent se présenter n'importe où. La prise en charge médicale est efficace, mais difficile. Le diagnostic hâtif améliore le pronostic individuel du patient et peut prévenir une exposition plus grave et la transmission à la population.

Introduction

About 15% of cases of tuberculosis (TB) present with extrapulmonary disease, and of those roughly 50% are centred in the lymph nodes. Scrofula, or tuberculous cervical lymphadenitis, makes up about 60% of these cases of TB. Although rare, such presentations are more common in women, minorities and immunocompromised patients, especially those with HIV.1,2 HIV and TB are the most prevalent infectious global killers, and their presence in the same individual is even more deadly.3,4 Since TB can spread rapidly within an immunocompetent population, suspecting its presence is imperative to protecting hospital staff and the population at large. We present a case of a neck abscess that was the initial presentation of both advanced HIV and disseminated TB.

Case presentation

A 28-year-old woman presented to the emergency department (ED) with the chief complaint of a neck abscess. She arrived...