SHM Converge Scientific Abstract ePoster Gallery-Before Scrofula Fools You: The Challenge of Diagnosing Tuberculosis Lymphadenitis

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This case describes a 34-year-old woman with a progressively enlarging painful left supraclavicular lymph node, night sweats, and weight loss. She had repeated evaluations and a prior biopsy treated as infection, but her lesion worsened and began draining pus. CT imaging showed a necrotic multiloculated neck mass, necrotic mediastinal lymphadenopathy, and small pulmonary nodules. She was ultimately diagnosed with cervical tuberculous lymphadenitis (scrofula) with concomitant pulmonary tuberculosis.<br /><br />The report emphasizes that tuberculous lymphadenitis is the most common form of extrapulmonary TB, but diagnosis is often delayed in low-prevalence settings like the United States because symptoms are nonspecific and clinicians may not suspect TB early. Risk factors such as being foreign-born, from East or South Asia, or exposure in high-risk environments should raise suspicion; in this case, the patient had no travel history but worked in a correctional facility.<br /><br />Key diagnostic points include:<br />- Fine needle aspiration is recommended as an initial test.<br />- Excisional biopsy should be pursued if less invasive testing is inconclusive or if needed for treatment.<br />- Culture remains the diagnostic gold standard in non-endemic regions, though results may take 3–8 weeks.<br />- MTB PCR can help support earlier treatment, but sensitivity is variable.<br />- Negative cultures do not exclude extrapulmonary TB and should prompt further evaluation.<br /><br />Treatment is typically 6 months of RIPE therapy, and clinicians should monitor for paradoxical worsening during treatment, especially in patients with HIV. The case highlights the need for high clinical suspicion, thorough risk assessment, and multidisciplinary workup to avoid delayed diagnosis and morbidity.

Asset Subtitle

Bindi Hira

Meta Tag

Author List Bindi Hira, Teresa Chueng

Category Clinical Vignettes

Concept Tuberculosis Lymphadenitis

Concept Extrapulmonary Tuberculosis

Concept Culture

Concept Cervical Lymphadenopathy

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization University of Miami

Presenting Author Bindi Hira

Track Adult

Keywords

tuberculous lymphadenitis

scrofula

cervical lymphadenopathy

pulmonary tuberculosis

necrotic neck mass

night sweats

weight loss

fine needle aspiration

RIPE therapy

extrapulmonary tuberculosis

Tuberculosis Lymphadenitis

Extrapulmonary Tuberculosis

Culture

Cervical Lymphadenopathy

Biopsy