The Journal of Emergency Medicine, Vol. 54, No. 6, pp. e141–e142, 2018 2018 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter https://doi.org/10.1016/j.jemermed.2018.02.004 Visual Diagnosis in Emergency Medicine Mikala Paciﬁque, MD, Carmen Alcala, MD, and Sean M. Bryant, MD Department of Emergency Medicine, Cook County Health and Hospitals System, Chicago, Illinois Reprint Address: Sean M. Bryant, MD, Department of Emergency Medicine, Cook County Health and Hospitals System, 1900 West Polk, 10th Floor, Chicago, IL 60612 CASE REPORT DISCUSSION A 41-year-old man presented to the Emergency Depart- Tuberculosis lymphadenitis is considered to be the local ment with a 1-day history of dyspnea. For the past manifestation of systemic disease, whereas lymphadenitis 3 months, he had noted an enlarging neck mass and due to nontuberculous mycobacteria is truly a localized dis- was recently prescribed antiretroviral therapy for a diag- ease (1). Scrofula (mycobacterium cervical lymphadenitis) nosis of acquired immune deﬁciency syndrome (CD4 is the most common extrapulmonary manifestation of 16 cells/mm ). Review of systems was positive for cough with blood-tinged sputum, fever, night sweats, and weight loss. Examination revealed diffuse wheezing and a right-sided, tender, erythematous cervical neck mass (Figure 1). A chest radiograph demonstrated bilat- eral diminutive nodules
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