Extension of Scrofula to Retropharyngeal Space and Cervical Spine
Extension of scrofula (tuberculous cervical lymphadenitis) to the retropharyngeal space and cervical spine is uncommon, occurring as isolated case reports rather than a typical pattern of disease progression.
Epidemiology and Typical Presentation
The classical presentation of scrofula is localized cervical lymphadenitis without deep space or skeletal involvement. The available evidence demonstrates:
In children aged 1-5 years, nontuberculous mycobacteria (particularly MAC) cause approximately 80% of mycobacterial cervical lymphadenitis, presenting as unilateral, non-tender cervical nodes without systemic symptoms or deep extension 1, 2
In adults, tuberculous lymphadenitis accounts for over 90% of culture-proven mycobacterial cervical lymphadenitis, but typically remains confined to lymph nodes 1, 3
Tuberculous cervical spine involvement (Pott's disease) is relatively rare despite tuberculous spondylitis being the most common bone and joint tuberculosis manifestation 4
Rare Extension Patterns
When extension does occur, it represents atypical and complicated disease:
Retropharyngeal Space Involvement
- Tuberculous retropharyngeal abscess is explicitly described as "a rare presentation" in the literature 5
- When it occurs, it is usually secondary to cervical spine tuberculosis in adults 6, 5
- Isolated retropharyngeal tuberculous abscess without spine involvement has been reported but is exceptional 5
Cervical Spine Involvement
- Pott's disease of the cervical spine, particularly the cervico-occipital junction, is documented in case reports as rare occurrences 4
- The combination of cervical spine tuberculosis with retropharyngeal abscess has been reported but remains uncommon 4, 6
High-Risk Populations
Extension to deep spaces and bone is more likely in immunocompromised patients, particularly:
- HIV/AIDS patients with advanced immunosuppression may present with disseminated tuberculosis including cervical manifestations 4, 7
- The first reported case of sub-occipital Pott's disease with retropharyngeal abscess occurred in an AIDS patient 4
- Scrofula in HIV-positive individuals carries higher risk of disseminated disease 7
Clinical Implications
Presentation Clues for Extension
When extension occurs, patients typically present with:
- Neurological signs (indicating spinal involvement) 4
- Dysphagia, hoarseness, and neck pain (suggesting retropharyngeal involvement) 6
- Insidious onset with fever and constitutional symptoms 6
Geographic Considerations
- In endemic tuberculosis regions, the baseline incidence of all tuberculous manifestations is higher, but extension patterns remain uncommon 8
- Tuberculosis is the most common cause of spinal infections worldwide, yet cervical spine involvement with retropharyngeal extension remains rare even in high-prevalence areas 8
In summary, while scrofula itself may be encountered with some frequency in endemic areas or high-risk populations, extension to the retropharyngeal space and cervical spine represents complicated, atypical disease documented primarily through case reports rather than case series, indicating true rarity.