Forget Nicolas, Challoner Kathryn
Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Int J Emerg Med. 2009 Aug 18;2(4):205-9. doi: 10.1007/s12245-009-0117-8.
In the US, scrofula is generally uncommon, but it may be the manifestation of disseminated tuberculosis in immunocompromised patients. Given the delay to obtain PPD results, AFB results, and cultures for TB, the emergency physician (EP) must rely on the history and physical examination to make the diagnosis of scrofula.
To illustrate a set of criteria that would be useful to the emergency physician to identify cases of scrofula.
We retrospectively reviewed the charts of patients with a final diagnosis of scrofula at our institution to identify the characteristics of patients who present to the emergency department with a neck mass that was eventually diagnosed as scrofula.
We found that being foreign born, being HIV+, and having a prior history of a positive PPD appeared to be associated with a diagnosis of scrofula.
This review suggests that scrofula should be included in the EP's differential diagnosis of neck in masses when patients present subacutely and they have significant TB risk factors. In such cases, the EP should strongly consider ruling out pulmonary TB.
在美国，瘰疬一般并不常见，但它可能是免疫功能低下患者播散性结核病的表现。鉴于获取结核菌素试验（PPD）结果、抗酸杆菌（AFB）结果以及结核培养结果存在延迟，急诊医生（EP）必须依靠病史和体格检查来诊断瘰疬。
阐述一套对急诊医生识别瘰疬病例有用的标准。
我们回顾性分析了本院最终诊断为瘰疬的患者病历，以确定因颈部肿块到急诊科就诊且最终被诊断为瘰疬的患者特征。
我们发现出生在国外、HIV阳性以及既往PPD试验结果为阳性似乎与瘰疬的诊断有关。
本综述表明，当患者亚急性就诊且有明显的结核病危险因素时，急诊医生对颈部肿块进行鉴别诊断时应考虑瘰疬。在这种情况下，急诊医生应强烈考虑排除肺结核。
