Scrofuloderma

A 25-year-old female patient from Nepal presented to our dermatology department with a 3-month history of swelling in the left supraclavicular area that was painful on palpation, a dry cough, and fever. Due to suspected scrofuloderma (tuberculosis cutis colliquativa), we performed computed tomography of the chest, revealing massive left mediastinal lymphadenopathy. This was followed by mediastinal lymph node puncture, as well as supraclavicular node excision. Histopathology revealed epithelioid-cell granulomas with necrosis. Diagnosis was confirmed by the detection of Mycobacterium tuberculosis by polymerase chain reaction. We initiated a quadruple therapy comprising rifampicin, isoniazid, ethambutol, and pyrazinamide. Since the antibiogram showed resistance to isoniazid, this drug was switched to levofloxacin. At 6 weeks, the patient’s general condition had significantly improved. Scrofuloderma is a subcutaneous manifestation of tuberculosis caused when underlying tuberculosis (in this case, of the lymph nodes) extends to the cutis and subcutis. Resistent pathogens are significantly more frequent in patients born abroad.

Figure

Swelling in the left supraclavicular area

Dr. med. Anna Sophie Wesselmann, Dr. med. Marina Rogacev, Dr. med. Waltraud Anemüller, Klinik für Dermatologie, Allergologie und Venerologie und
Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck; [e-mail]

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Wesselmann AS, Rogacev M, Anemüller W: Scrofuloderma. Dtsch Arztebl Int 2021; 118: 846b. DOI: 10.3238/arztebl.m2021.0172