Cervical tuberculous lymphadenitis presenting with scrofuloderma: a clinical image

A 36-year-old man presented with a two-month history of a progressively enlarging swelling in the left submandibular region. The swelling was initially painless but gradually became tender and was associated with purulent discharge. He also reported constitutional symptoms, including low-grade fever, weight loss, and malaise. Physical examination revealed multiple matted cervical lymph nodes in the left submandibular region. The overlying skin demonstrated ulceration with multiple draining sinus tracts, adherent crusts, surrounding induration, and violaceous discoloration, consistent with cutaneous extension of an underlying tuberculous lymphadenitis. Fine-needle aspiration cytology of the enlarged lymph node showed granulomatous inflammation with caseous necrosis. Ziehl-Neelsen staining demonstrated acid-fast bacilli, confirming the diagnosis of tuberculosis. Based on the clinical, cytological, and microbiological findings, a diagnosis of scrofuloderma secondary to cervical tuberculous lymphadenitis was established. Scrofuloderma is an uncommon manifestation of cutaneous tuberculosis resulting from the direct contiguous spread of Mycobacterium tuberculosis from an underlying infected focus, most commonly cervical lymph nodes, bones, or joints. It typically presents as painless subcutaneous nodules that gradually soften, ulcerate, and form multiple draining sinus tracts discharging caseous material. Healing usually occurs with characteristic puckered, fibrotic, and atrophic scarring. Early recognition of this entity is essential, particularly in tuberculosis-endemic regions, as prompt antitubercular therapy can prevent disease progression and minimize permanent scarring.