This post is an answer to the Case – Swollen Mass on the Neck
Fine-needle aspiration initially revealed benign cystic contents. He was started on clindamycin empirically, but the swelling progressed and the mass became increasingly erythematous. Tuberculosis skin testing was positive (>20 mm). Serologic testing for the human immunodeficiency virus was negative.
Computed tomography of the mass showed multilobulated soft-tissue lesions along the right submandibular gland and superficial to the right parotid gland. The culture from the aspirate eventually grew out Mycobacterium tuberculosis.
A diagnosis of tuberculous lymphadenitis with cutaneous extension (scrofuloderma) was made, and the patient was started on antituberculous therapy. He completed 6 months of treatment and was subsequently lost to follow-up.
Scrofuloderma occurs when the skin becomes involved by direct extension from an underlying tuberculous infection (usually lymphadenitis). Although uncommon, scrofuloderma should be considered in cases of persistent lymphadenitis, particularly when there is cutaneous extension in patients from countries where tuberculosis is endemic.
