# Scrofula: an uncommon tuberculosis manifestation reappearing in Italy

## TL;DR

An 88-year-old man with a history of lymphoma was diagnosed with scrofula, a rare form of tuberculosis, highlighting the challenges in diagnosing this condition in high-risk patients.

## Contribution

The paper presents a case emphasizing the diagnostic difficulties of scrofula in elderly patients with prior oncological history.

## Key findings

- Scrofula can mimic malignancy in elderly patients with a history of cancer.
- Fine-needle aspiration cytology helped confirm the diagnosis of tuberculous lymphadenitis.
- Antitubercular therapy led to clinical improvement without recurrence.

## Abstract

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.