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Scrofuloderma: A diagnostic dilemma in primary care.

S Md Rifin1, M S E Shalihin2, M Mat Jidin3

  • 1Klinik Kesihatan Bandar 32, Bera, Pahang, Malaysia. itsonlyme_smr@yahoo.ca.

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|May 25, 2021
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Summary

Scrofuloderma, a skin infection, was diagnosed in a patient with cervical swelling and ulcers. Anti-tuberculosis therapy led to gradual healing of the lesions.

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Microbiology

Background:

  • Scrofuloderma is a cutaneous manifestation of tuberculosis (TB).
  • It commonly affects the head and neck region, often secondary to underlying tuberculous lymphadenitis.
  • Early diagnosis and treatment are crucial for favorable outcomes.

Observation:

  • A 35-year-old female presented with a month-long history of multiple cervical swellings and ulcers.
  • Lesions evolved from papules to nodules and pustules, accompanied by low-grade fever and weight loss.
  • Initial investigations, including chest X-ray and sputum smear for acid-fast bacilli, were negative.

Findings:

  • Histopathology of skin biopsy confirmed Scrofuloderma, showing epidermal necrosis, granulomatous tissue, abscess formation, and histiocyte infiltrates.
  • Fine needle aspiration cytology (FNAC) of cervical lymph nodes suggested tuberculous lymphadenitis.
  • The patient was initiated on anti-tuberculosis therapy.

Implications:

  • This case highlights the importance of considering Scrofuloderma in patients with cervical lesions, even with negative initial TB investigations.
  • Prompt diagnosis through histopathology and FNAC, followed by appropriate anti-tuberculosis treatment, can lead to successful resolution of Scrofuloderma.
  • Effective management of Scrofuloderma can prevent further complications and improve patient quality of life.