Cervical Tuberculosis Lymphadenitis (Scrofula) in Wisconsin: Case Report, Pitfalls, and Challenges

This case report presents a case of cervical tuberculous lymphadenitis (scrofula) in Wisconsin, illustrating the diagnostic challenges in a low-prevalence setting. It emphasizes the importance of including tuberculosis (TB) in the differential diagnosis of persistent cervical lymphadenopathy, particularly in patients with a history of latent TB infection.

A 37-year-old woman presented with a persistent, painless left-sided neck mass without local warmth or erythema, characteristic of a cold abscess. Initial imaging demonstrated lymph node abnormalities, while multiple diagnostic tests were inconclusive. After misdiagnosis and unsuccessful treatments, she was eventually diagnosed with TB lymphadenitis. She completed a prolonged course of antituberculous therapy, followed by surgical intervention, with complete resolution of symptoms.

This case underscores the need for a high index of suspicion for tuberculosis in patients with chronic cervical lymphadenopathy, even in regions with low TB prevalence. It also highlights the importance of thorough clinical and exposure history and the potential for diagnostic delay in atypical presentations, particularly when medical records are fragmented across health care systems.