Scrofula: emergency department presentation and characteristics.

Area of Science:

• Infectious Diseases
• Public Health
• Emergency Medicine

Background:

• Scrofula, or tuberculous lymphadenitis, is rare in the US but can indicate disseminated tuberculosis (TB) in immunocompromised individuals.
• Diagnosis in the emergency department is challenging due to delays in definitive TB testing (PPD, AFB, cultures).

Purpose of the Study:

• To identify clinical criteria for emergency physicians to diagnose scrofula.
• To aid in the early identification of scrofula in the emergency department setting.

Main Methods:

• Retrospective chart review of patients diagnosed with scrofula.
• Analysis of patient characteristics presenting with neck masses to the emergency department.

Main Results:

• Foreign-born status was associated with scrofula.
• HIV-positive status was associated with scrofula.
• A history of a positive purified protein derivative (PPD) test was associated with scrofula.

Conclusions:

• Scrofula should be considered in the differential diagnosis of subacute neck masses, especially in patients with TB risk factors.
• Emergency physicians should consider ruling out pulmonary TB in suspected scrofula cases.