Scrofula: an uncommon tuberculosis manifestation reappearing in Italy

Cervical tuberculous lymphadenitis (scrofula) is the most frequent form of extrapulmonary tuberculosis and may mimic malignant or other infectious conditions, especially in elderly patients or those with a prior oncological history. We report the case of an 88-year-old male with a history of treated lymphoma and chronic anticoagulation for atrial fibrillation, who presented with a rapidly enlarging cervical mass initially suggestive of malignancy. Cervical ultrasound revealed lymphadenopathies with no thyroid involvement. Fine-needle aspiration cytology (FNAC) excluded carcinoma and demonstrated caseous-purulent material. Microbiological and cytological analyses confirmed tuberculous lymphadenitis. Antitubercular therapy was initiated with progressive clinical improvement and no recurrence during follow-up. This case underscores the diagnostic challenges of scrofula, particularly in high-risk populations. FNAC is a valuable diagnostic tool, although repeat procedures or excisional biopsy may be required. Clinicians should maintain a high index of suspicion for tuberculosis in cases of atypical cervical lymphadenopathy to ensure timely diagnosis and treatment.