bubble_chart Overview

Cervical lymph nodes, referred to as "scrofula" in Chinese medicine, are commonly seen in children and young adults. The bacilli usually invade through the tonsils or dental caries, with a minority of cases secondary to pulmonary or bronchial subcutaneous node lesions. However, the disease only manifests when the body's resistance is weakened. The disease course typically lasts 1 to 3 months or longer. Multiple enlarged lymph nodes are present, scattered and movable. As the disease progresses, they may fuse into fixed, immobile masses, eventually undergoing caseous necrosis to form cold abscesses, which may rupture and develop into chronic sinuses. Chest X-rays may reveal subcutaneous node lesions.

bubble_chart Clinical Manifestations

There are multiple swollen lymph nodes of varying sizes on one or both sides of the neck, usually located along the anterior and posterior borders of the sternocleidomastoid muscle. In the initial stage [first stage], the swollen lymph nodes are firm, painless, and movable. As the disease progresses, periadentitis occurs, causing the lymph nodes to adhere to the skin and surrounding tissues. The lymph nodes may also adhere to each other, forming a conglomerate mass that is difficult to move. In the advanced stage, caseous necrosis and liquefaction of the lymph nodes occur, leading to the formation of a cold abscess. After the abscess ruptures, it discharges pus resembling bean dregs or thin rice soup, eventually forming a persistent sinus or chronic ulcer. The ulcer edges exhibit dark red skin with undermining, and the granulation tissue appears pale and edematous. The aforementioned pathological changes at different stages may coexist in the lymph nodes of the same patient. If the patient's resistance improves and appropriate treatment is administered, the subcutaneous node lesions may cease progression and calcify.

A small number of patients may experience systemic toxic symptoms such as low-grade fever, night sweating, loss of appetite, and weight loss.

bubble_chart Diagnosis

Based on the history of subcutaneous node disease and local signs, especially when a cold abscess has formed or has ruptured to form a persistent sinus or ulcer, a clear diagnosis can often be made. If necessary, a chest X-ray can be performed to determine the presence of pulmonary lesions. For pediatric patients, a subcutaneous node bacillus test can aid in diagnosis. If there is only cervical lymph node enlargement without the formation of a cold abscess or ulcer,

bubble_chart Treatment Measures

For systemic treatment of this disease, anti-tuberculosis therapy can be used. A few localized and movable lymph nodes can be surgically removed if they are relatively large. For cold abscesses that have not yet ruptured, aspiration of pus and injection of anti-tuberculosis drugs can be performed. For chronic suppurative sinuses that have already formed due to rupture, incision and curettage can be done along with dressing changes using anti-tuberculosis drugs.

(1) Systemic treatment: Pay appropriate attention to nutrition and rest. Take isoniazid orally for 1–2 years; for those with systemic toxic symptoms or subcutaneous node lesions elsewhere in the body, add sodium para-aminosalicylate or rifampicin orally, or supplement with intramuscular streptomycin injections.

(2) Local treatment

1. For a few localized, relatively large, and movable lymph nodes, surgical removal may be considered. During surgery, take care not to injure the accessory nerve.

2. For cold abscesses that have formed but not yet ruptured, potential aspiration of pus can be performed. Insert the needle from the normal skin around the abscess, aspirate as much pus as possible, then inject a 5% isoniazid solution or 10% streptomycin solution into the abscess cavity for irrigation, leaving an appropriate amount in the cavity. Repeat twice weekly.

3. For cold abscesses that have ruptured to form ulcers or sinuses, if secondary infection is not evident, curettage can be performed, carefully removing all the subcutaneous node lesion tissue. Do not suture the wound; instead, use a streptomycin solution for dressing changes.

4. For cold abscesses with secondary suppurative infection, incision and drainage should be performed first. Once the infection is under control, curettage can be carried out if necessary.

bubble_chart Prevention

Conduct health education to develop good habits of not spitting anywhere. Children should receive the BCG vaccine. Maintaining oral hygiene, early treatment of dental caries, and removal of diseased tonsils also hold certain significance in prevention.