Search

Case Presentation: A 32-year-old male who recently immigrated from Kenya presented to the emergency department (ED) with a painful, enlarging, right-sided neck mass for eight weeks duration. Point-of-care ultrasound was used to reveal a large cystic mass with internal septations and numerous hypoechoic round lesions. Initial tuberculosis blood test ordered in the ED was positive with cultures ultimately growing Mycobaceterium tuberculosis.Discussion: Scrofula should be considered in the differential in patients presenting with enlarging neck masses who have epidemiological risk factors for tuberculosis.

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This essay argues that scrofula was one of several disorders, including gout, rickets, and venereal disease, that were 'rebranded' as hereditary in response to broader cultural changes that took place during the Restoration and eighteenth century in England. While the purposes of scrofula's recategorisation were more political than medical, they resulted in this heretofore relatively obscure childhood ailment assuming a new prominence within both medical and popular discourses of the period. Scrofula became both emblem and proof of the links between sexual promiscuity, financial profligacy, and physiological degeneration, its symbolic status reinforced by the legal and moral language used to model processes of hereditary transmission. By likening the inheritance of scrofula to the inheritance of original sin—or, more commonly, to the inheritance of a 'docked entail' or damaged estate—eighteenth-century writers and artists not only made this non-inherited ailment into a sign of catastrophic hereditary decline; they also paved the way for scrofula to be identified as a disease of aristocratic vice, even though its association with crowded, unsanitary living conditions likely made it more common among the poor. By the same token, financial models of disease inheritance facilitated a bias toward paternal transmission, with scrofula often portrayed as passing, like a title or an estate, from father to son rather than from mother to daughter. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tuberculous lymphadenitis or scrofula, also called colliquative tuberculosis, caused by Mycobacterium tuberculosis is the most common clinical form of extrapulmonary tuberculosis. However, at present it is of rare occurrence and there are no reports in Ecuador. CLINICAL CASE: A 75-year-old female patient with 2 years of evolution of adenopathies in the neck, which abscessed and drained spontaneously, leaving scars. Acid-alcohol bacilli (BAAR) was observed in the aspirate of one of the lymph nodes by the Ziehl-Neelsen technique, initiating treatment with pyrazinamide, isoniazid, rifampicin, and ethambutol for six months. In subsequent controls, fistula closed and flattening of the lymph nodes were observed, and clinical cure was determined. CONCLUSIONS: Since this is a rare clinical presentation of M. tuberculosis infection, its publication is important to alert health workers, for its early diagnosis and timely treatment. [ABSTRACT FROM AUTHOR]

In his work written in 1924 Les rois thaumaturges, Marc Bloch highlighted an important issue that contributes to our understanding of power and royalty in the Middle Ages. Scholars have been deepening research in the field since then, looking for the reasons behind the "royal touch" and for an eventual quest for legitimacy for those kings who strive to see their authority recognized. Should we reduce the touch to a mere strategy to gain consensus? Or should we look for deeper reasons by "questioning" the kings and their hypothetical belief in touch, along with the trust in their healing powers? It must be acknowledged that subjects were loyal to the body of the king first, and the body was the very center of the political realm throughout the Middle Ages. In this paper we are going to try to look for a different path analyzing Bloch's findings and proposing research questions that should be taken into consideration in both studies on royalty in the Middle Ages, and on the origins of the legitimization of power. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) can infect both pulmonary and extra-pulmonary organs. In India pulmonary TB accounts for 80% of cases and extrapulmonary TB (EPTB) accounts for 20% cases. Cervical lymph nodes are the most location for EPTB. Aims and Objectives: To study the efficacy of treatment with oral steroids along with anti-tuberculosis treatment in cervical lymph node tuberculosis. Methods: A total of 60 patients were enrolled in the study all with EPTB and cervical lymphadenitis. These 60 study patients were randomised into two groups. Group-I consisted of 30 patients given anti-tuberculosis therapy along with prednisolone 1mg/kg body weight for 4 weeks followed by tapering at 0.5 mg/kg body weight over 4 weeks. Group-II was comprised of 30 patients given antituberculosis treatment plus placebo Results: After completion of treatment 27 patients in Group I (90%) showed complete resolution and 3 patients (10%) had residual evidence of lymphadenitis with no change. In contrast, only 19 patients (63.3%) showed complete resolution in Group 2 and 11 patients (36.7%) had residual lymphadenitis present (10 had no change, 1 had increase in size). Conclusion: We conclude that steroids given with antituberculosis treatment to patients with cervical lymphadenitis led to faster and earlier resolution of tuberculous lymphadenitis.

Abstract Although tuberculosis manifests mostly as a pulmonary disease, extrapulmonary presentations can occur and must be taken into consideration depending on the clinical setting.

Cervical tuberculous lymphadenitis (CTL), also known as scrofula, is an extrapulmonary manifestation of tuberculosis, a disease that is endemic to many developing countries, particularly Sub-Saharan Africa and Asia, but may also be found worldwide in developed countries like the United States. CTL can be difficult to detect and may mimic other similar-appearing conditions, so a high index of suspicion is required to accurately diagnose the condition when a patient presents with one or more neck masses. Incision and drainage and excisional surgery are aggressive options available to treat CTL but are not preferred due to a high risk of serious adverse events like fistulization and hematological dissemination. Clinicians typically opt for traditional tubercular RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) therapy for its high efficacy in treating extrapulmonary tuberculosis. Despite this preference, RIPE therapy has been known to elicit a myriad of side effects that demand close monitoring by clinicians. One side effect of the RIPE regimen that has yet to be reported is acanthosis nigricans (AN), a dermatological sign that presents as thickening and darkening of the skin, often in intertriginous areas. AN frequently occurs in conjunction with insulin resistance, and interestingly, the RIPE drug isoniazid has been implicated in insulin derangements in patients, most notably diabetics. However, the incidence of AN secondary to isoniazid use has not been explicitly recorded in the literature to date. Herein we present a novel case of a young man from Nepal with CTL treated via RIPE therapy who developed AN likely secondary to isoniazid use., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Meade et al.)

Tuberculous lymphadenitis constitutes up to 40% of extrapulmonary tuberculosis. Chronic cervical lymphadenopathy may be the only manifestation of extrapulmonary tuberculosis in the head and neck region. Symptoms, clinical findings and prognosis differ greatly depending on the host’s immune system, existing comorbidities, site and extension of infection as well as early diagnosis and commencement of treatment. We report a case of miliary tuberculosis with both pulmonary and extrapulmonary involvement in a healthy male who was successfully treated with surgical drainage of neck abscess followed by 9 months of an anti-tuberculosis drugs treatment.

Tuberculosis (TB) is still one of the major public health problems worldwide. TB is an infectious disease caused by Mycobacterium tuberculosis. It typically affects the lungs (pulmonary tuberculosis), but may also occur in other sites (extrapulmonary tuberculosis). Cervical tubercular lymphadenitis is one of the most common localizations of extrapulmonary tuberculosis [1,2]. We present a case of a 57-year old man with a history of 3-month weakness and swollen, bilaterally inflamed cervical lymph nodes. Cervical tubercular lymphadenitis accompanying with pulmonary tuberculosis was diagnosed. Moreover, we carry out the differential diagnosis of the cervical lymphadenopathy.

Tuberculosis represents a global health challenge and is one of the leading infectious killers, with over a million people succumbing to it every year. While the disease is primarily prevalent in developing countries, where 95% of cases and deaths occur, doctors around the globe need to be able to recognize its diverse clinical manifestations in order to initiate appropriate treatment early. The granulomatous infection caused by Mycobacterium tuberculosis typically affects the lungs, but isolated abscesses in the head and neck region can be a less common presentation of the disease, potentially resulting in dysphagia, odynophagia, voice changes, neck swelling, bone erosion, and even life-threatening respiratory distress requiring tracheostomy. Here, characteristic imaging findings and potential surgical options are discussed.

Tuberculosis (TB) is one of the top 10 causes of death worldwide. Multidrug-resistant tuberculosis (MDR-TB) occurs when at the minimum there is resistance to isoniazid and rifampin. Prevention of new infections of Mycobacterium tuberculosis and progression to TB disease is critical to reduce the burden and mortality of this disease. We present the case of a 73-year-old human immunodeficiency virus (HIV)-negative female who presented with cervical lymphadenopathy and who was diagnosed with MDR-TB.

This article tells the story of an eighteenth-century medical pamphlet called An essay on the nature and cure of the King’s Evil, deduced from observation and practice. This was written by John Morley (d. 1776/7), a wealthy Essex landowner who advertised free medical treatments. The pamphlet is one of many short tracts on scrofula produced after the ceremony of ‘the royal touch’ ceased with the death of Queen Anne. However, it merits special attention from historians of medicine and historians of the book because it was edited and reprinted many more times than other surviving scrofula tracts: 42 editions appeared between 1760 and 1824. This suggests significant popularity. The Essay is also of interest because the first fifteen editions display changes and additions completed by Morley before his death in late 1776 or early 1777. Between these versions, Morley consistently refashioned his identity as practitioner and author. He also adjusted his portrayal of the intended readers of the pamphlet: in later editions, readers are recorded using the Essay in increasingly complex and autonomous ways to design their own medical treatments. The pamphlet is therefore testimony to the fluid relationship between practitioner and patient. It shows that seemingly simple, formulaic and easy-to-read forms like pamphlets and case studies could play a variety of complex and shifting roles in eighteenth-century medical encounters and the construction of healing knowledge.

Considering that before antibiotics and vaccination the course of tuberculosis depended mostly on the patient's immune response, this study tested the hypothesis that the mortality profile remained similar during the transition from the 19th to 20th century. The biographical data of the individuals buried in the Coimbra Municipal Cemetery of Conchada were analysed, and the records of those who were born in the city and had tuberculosis registered as the cause of death were analysed using SPSS. The years of death were grouped: 1861–1870 (n = 124, 22.5%), 1871–1880 (n = 234, 42.4%), and 1910–1914 (5 years, n = 194, 35.1%). Mortality by tuberculosis has increased over the years. A total of 552 individuals, 242 females (43.8%) and 310 males (56.2%) died of tuberculosis (p < 0.05). The mean age at death (min = 11 days, max = 86 years) decreased over time, respectively 51.8, 53.1, and 35.8 years-old for individuals >20. Deaths by pulmonary tuberculosis (n = 38, 1861–1870; n = 115, 1910–1914) and meningeal tuberculosis (n = 0, 1861–1870; n = 48, 1910–1914) increased over time, whereas scrofula decreased (n = 23, 1861–1870; n = 3, 1910–1914). Only a 12 years-old male (0.2%) died of bone tuberculosis. Infant (0-3 years-old) mortality occurred mainly (50.5%,48/95) between July and October. The hypothesis tested was not confirmed. Death by tuberculosis has increased, which may be a consequence of population growth, deterioration of the living conditions, and/or changes in bacterial virulence and/or in the host immune system. [ABSTRACT FROM AUTHOR]

Introduction: In the clinical medicine's immediate assistance unit, care is focused on outpatients with diseases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA., Methods: Observational, descriptive, retrospective., Period: 2017-2023., Results: Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admission and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died., Discussion: TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

This article tells the story of an eighteenth-century medical pamphlet called An essay on the nature and cure of the King's Evil, deduced from observation and practice. This was written by John Morley (d. 1776/7), a wealthy Essex landowner who advertised free medical treatments. The pamphlet is one of many short tracts on scrofula produced after the ceremony of 'the royal touch' ceased with the death of Queen Anne. However, it merits special attention from historians of medicine and historians of the book because it was edited and reprinted many more times than other surviving scrofula tracts: 42 editions appeared between 1760 and 1824. This suggests significant popularity. The Essay is also of interest because the first fifteen editions display changes and additions completed by Morley before his death in late 1776 or early 1777. Between these versions, Morley consistently refashioned his identity as practitioner and author. He also adjusted his portrayal of the intended readers of the pamphlet: in later editions, readers are recorded using the Essay in increasingly complex and autonomous ways to design their own medical treatments. The pamphlet is therefore testimony to the fluid relationship between practitioner and patient. It shows that seemingly simple, formulaic and easy-to-read forms like pamphlets and case studies could play a variety of complex and shifting roles in eighteenth-century medical encounters and the construction of healing knowledge. [ABSTRACT FROM AUTHOR]

Peritoneal tuberculosis (PTB) is a common type of extrapulmonary tuberculosis; however, due to variety of clinical presentations, diagnostic challenges do occur. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. In addition, PTB can mimic a malignancy, especially in women who present with ascites and elevated cancer antigen (CA) 125 levels. A high index of suspicion is an important factor in an early diagnosis. Moreover, an early diagnosis and the initiation of antituberculous therapy are essential for preventing morbidity and mortality. Fortunately, most of these patients respond very well to standard antituberculous therapy. Here, we have reported the case of a young female patient who presented with chronic ascites, mild abdominal tenderness, and later, scrofula. Ultimately, she was diagnosed with PTB based on her test results. We expect that this case report will contribute to the existing literature on this subject. [ABSTRACT FROM AUTHOR]

This essay analyzes the correspondence between Grand Prince Vasilii III and his wife Elena (née Glinskaia). Only Vasilii III's part of this correspondence, consisting of five letters, has been preserved. All five letters reveal the grand prince's great concern for his family's health; and in particular, the letters describe an early childhood disease of the grand prince's eldest son Ivan, the future Ivan IV (the Terrible). In an earlier analysis (in 1993) of the grand prince's description of this illness found in these letters, Edward Keenan argued that the young boy likely suffered from tuberculosis or scrofula. In this essay, I reexamine the grand prince's description of his son's illness and argue against a pathologization of Ivan's whole life based only on second-hand descriptions of a childhood illness by his father. From the letters themselves, as well as from contemporary physicians' descriptions, there can be no certainty that the illness was ever anything more than an early childhood disease that passed, with no effect upon the later life of Tsar Ivan IV. [ABSTRACT FROM AUTHOR]

Children are more likely than adults to develop extra-pulmonary tuberculosis (EPTB), which often presents as cervical lymphadenopathy. The role of surgery in management is uncertain. We reviewed all head and neck EPTB cases presenting to our tertiary care pediatric institution over a twelve-year period. All children 18 years of age and younger with EPTB involving the head and neck were included. We recorded clinical data and age at diagnosis, birth country, BCG vaccination status, as well as radiographic, surgical, histological, and microbiological results. All 16 patients presented with cervical lymphadenopathy. Fourteen were born outside of Canada in TB endemic areas and all had foreign-born parents. Diagnosis was confirmed microbiologically from lymph node biopsies in 14 cases. Multi-drug resistant TB was identified in two cases: both had previous excisional node biopsies that had not been cultured. Two patients had culture negative suppuration despite adequate anti-tuberculous treatment that required surgery for cure. Ongoing suppuration despite appropriate drug therapy is seen in a minority of patients. We found that excisional lymph node biopsy of diseased cervical lymph nodes is diagnostic, and also therapeutic in some cases with ongoing suppuration despite appropriate drug therapy. Mycobacterial culture of lymph nodes is important for diagnosis and determination of drug resistance patterns. [ABSTRACT FROM AUTHOR]

Background : Oral lesions of tuberculosis (TB) are rare and usually associated with the secondary form of the disease. Aim : The aim of the present study was to determine the prevalence of oral lesions in a cohort of TB-infected individuals. Materials and Methods : The study was carried out in two reference centers for the treatment of TB in Recife, Brazil. All patients treated for TB in the period from July 2008 to March 2009 were included in the study. The data was subjected to descriptive statistical analysis. Results : One hundred and twenty-one patients were included in the study. A marked male prevalence was observed, with a male:female ratio of 6.12:1. HIV coinfection was a common event (33%). Head and neck lesions of TB were rare. Cervical node enlargement was observed in seven individuals (5.8%) and oral ulceration in one patient (0.8%). Discussion : The low prevalence of oral lesions of TB is in accordance with other studies. Nodal involvement is the most common form of head and neck disease. Conclusion : While TB may be a common accompanying feature of HIV disease, orofacial complications of TB are rare in individuals resident in northern Brazil.

Tuberculosis represents a global health challenge and is one of the leading infectious killers, with over a million people succumbing to it every year. While the disease is primarily prevalent in developing countries, where 95% of cases and deaths occur, doctors around the globe need to be able to recognize its diverse clinical manifestations in order to initiate appropriate treatment early. The granulomatous infection caused by Mycobacterium tuberculosis typically affects the lungs, but isolated abscesses in the head and neck region can be a less common presentation of the disease, potentially resulting in dysphagia, odynophagia, voice changes, neck swelling, bone erosion, and even life-threatening respiratory distress requiring tracheostomy. Here, characteristic imaging findings and potential surgical options are discussed. [ABSTRACT FROM AUTHOR]

Based on data mining technology, the rules of acupoint selection of acupuncture-moxibustion for scrofula in ancient times were analyzed. The relevant articles of acupuncture and moxibustion for scrofula were searched in the Chinese Medical Code , and the original article, acupoint name, acupoint characteristic, and acupoint meridian tropism, etc. were screened and extracted. The Microsoft Excel 2019 was used to establish a acupoint prescription database, and the frequency of acupoints as well as their meridian tropism and characteristics were analyzed. The SPSS21.0 was applied to perform cluster analysis of acupuncture prescriptions; the SPSS Modeler 18.0 was used to perform the association rules analysis of the neck and the chest-armpit acupoints, respectively. As a result, 314 acupuncture prescriptions were extracted, including 236 single-acupoint prescriptions and 78 multiple-acupoints prescriptions (53 for neck and 25 for chest-armpit). A total of 54 acupoints were involved, with a total frequency of 530. The top 3 commonly-used acupoints were Tianjing (TE 10), Zulinqi (GB 41) and Taichong (LR 3); the most commonly-used meridians were hand shaoyang meridian, foot shaoyang meridian, hand yangming meridian and foot yangming meridian; the most commonly-used special acupoints were he -sea points and shu- stream points. The cluster analysis obtained 6 clusters, and the association rule analysis obtained that the core prescriptions of the neck were Quchi (LI 11), Jianyu (LI 15), Tianjing (TE 10) and Jianjing (GB 21), while the core prescriptions of the chest-armpit were Daling (PC 7), Yanglingquan (GB 34), Danzhong (CV 17), Jianjing (GB 21), Waiguan (TE 5), Zhigou (TE 6), Yuanye (GB 22) and Zhangmen (LR 13). The core prescriptions obtained from association rule analysis by difference areas were basically consistent with those by cluster analysis of total prescriptions.

Although tuberculosis manifests mostly as a pulmonary disease, extrapulmonary presentations can occur and must be taken into consideration depending on the clinical setting. [ABSTRACT FROM AUTHOR]

This article presents an Irish magical cure for scrofula, reported by the New York Times in 1858, as a means to discuss the significance of Irish magical healing in the U.S. and how archaeologists might be able to recognize its material traces. Because of how magic has been historically understood in the West, 19th-century Americans used examples of Irish magic to bolster anti-Irish stereotypes and behaviors. Magical healing, nevertheless, was an important and effective strategy for the Irish who suffered from a dramatic increase in illnesses and injuries in the U.S. It was an integral part of their worldview, and it influenced how they interpreted new healing commodities like patent medicines. This article encourages archaeologists to reconsider the importance of magical healing in the past and the present. [ABSTRACT FROM AUTHOR]

The diagnosis of tuberculosis in immunocompromised hosts is often difficult as the hosts have atypical tuberculosis symptoms. The current study presents a case of scrofula and pulmonary tuberculosis with acute myelocytic leukemia (AML). As the disease became aggravated, the patient presented with fever, hemophagocytosis in the bone marrow, lymphadenopathy of the supraclavicular fossa, and mediastinal and nodular shadow in the chest by computed tomography. The symptoms presented successively or were coexistent, which made differentiation between tuberculosis, lymphoma, AML infiltration or other infections challenging. The diagnosis of tuberculosis was based on clinical and radiographic observations, morphological observation of the biopsies and the positive effect of antituberculosis drugs, while Ziehl-Neelsen stainings for acid fast bacilli were negative. The patient was treated with antituberculosis drugs, while receiving chemotherapy for AML. It is important to distinguish tuberculosis in adults with AML from other causes of fever, mediastinal masses in radiographic observations and hemophagocytosis in the bone marrow. [ABSTRACT FROM AUTHOR]

Cervical tuberculous lymphadenitis is mainly diagnosed by analyzing tissue samples obtained by fine-needle aspiration (FNA). However, some cases remain diagnostic challenges even after polymerase chain reaction analysis of FNA specimens. To delineate differences between cases that are relatively easy to diagnose and those for which diagnosis is difficult, 22 patients with cervical tuberculous lymphadenitis were studied retrospectively. FNA tissues were used to diagnose 14 cases (group A), whereas excisional biopsy was required for accurate diagnosis of 8 cases (group B). These two groups were compared with regard to results of blood examinations, ultrasound appearance, and various other procedures required to reach the final diagnosis. The results indicated that diagnosis of cervical tuberculous lymphadenitis was more difficult for patients with lower white blood cell counts, lower serum C-reactive protein levels, and absence of lymph node fusion or abscess formation on ultrasonography. The possibility of tuberculosis as a cause of cervical lymphadenopathy should always be considered, even when the presenting symptoms are not typical of this disease. [ABSTRACT FROM AUTHOR]

Background: Oral lesions of tuberculosis (TB) are rare and usually associated with the secondary form of the disease. Aim: The aim of the present study was to determine the prevalence of oral lesions in a cohort of TB-infected individuals. Materials and Methods: The study was carried out in two reference centers for the treatment of TB in Recife, Brazil. All patients treated for TB in the period from July 2008 to March 2009 were included in the study. The data was subjected to descriptive statistical analysis. Results: One hundred and twenty-one patients were included in the study. A marked male prevalence was observed, with a male:female ratio of 6.12:1. HIV coinfection was a common event (33%). Head and neck lesions of TB were rare. Cervical node enlargement was observed in seven individuals (5.8%) and oral ulceration in one patient (0.8%). Discussion: The low prevalence of oral lesions of TB is in accordance with other studies. Nodal involvement is the most common form of head and neck disease. Conclusion: While TB may be a common accompanying feature of HIV disease, orofacial complications of TB are rare in individuals resident in northern Brazil. [ABSTRACT FROM AUTHOR]

Abstract: Cervical lymphadenitis as a result of nontuberculous mycobacteria, otherwise known as scrofula, is a disease occurring almost exclusively in immunocompetent young children. The most frequent mycobacterial species responsible is Mycobacterium avium, but a large number of other species may also be involved. The epidemiology of such disease is revised here, and the impact of different species as causative agents of adenitis is also discussed. [Copyright &y& Elsevier]

Abstract: Samuel Johnson, the acclaimed author of the Dictionary of the English Language, survived childhood scrofula with impaired sight and hearing. The cause of his scrofula has been attributed to bovine tuberculosis, but mycobacterial infection does not satisfactorily account for the peculiar features of Johnson’s eye disorder or his hearing loss. The subject of numerous biographies, Johnson may have the most scrutinized medical history of all time. Medical detectives, hampered by the vagueness of 18th-century diagnosis, suspect that phlyctenular eye disease related to tuberculosis was the reason for his visual impairment. Pediatric brucellosis can also explain childhood scrofula associated with visual and auditory disabilities, but it may be difficult to reconcile any single diagnosis given the uncertainties surrounding Johnson’s medical and ocular histories. [Copyright &y& Elsevier]

Abstract: Objective: To describe a clinical staging system for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis that has both diagnostic and therapeutic implications. Methods: A Medline database search was performed using key words “nontuberculous mycobacteria”. All articles pertaining to nontuberculous mycobacterial cervicofacial lymphadenitis were reviewed for data evaluation regarding diagnosis and treatment methodologies. Results: Nontuberculous cervicofacial lymphadenitis infections pass through distinctly segmented clinical phases. In Stage I, a painless mass presents with notable increase in vascularity. Stage II is characterized by liquefaction of the affected lymph node, causing the mass to appear fluctuant. Significant skin changes characterize Stage III, whereby overlying skin may develop violaceous discoloration and become notably thinner, or parchment-like, with a “shiny” appearance. During Stage IV, the lesion fistulizes to the skin surface causing a draining wound. Conclusions: While nontuberculous mycobacterial cervicofacial lymphadenitis has typically been thought of as a surgical disease, further characterization is warranted. We present a new classification system for appraising the clinical stages of nontuberculous mycobacterial cervicofacial lymphadenitis that may be used as part of a greater approach to disease management: (1) after other causes have been ruled out, the possibility of a tuberculous scrofula must be eliminated, and the degree of diagnostic suspicion must be categorized; (2) the clinical stage of the infection can be determined using the classification system described; and (3) a stage-specific treatment may be chosen based on the individual patient. [Copyright &y& Elsevier]