Scrofula, or tuberculous cervical lymphadenitis, though now rare, is more commonly seen in minorities, women and immunosuppressed patients, especially those with HIV. We discuss a patient who presented to the emergency department with an anterior neck abscess and was diagnosed with both advanced HIV and disseminated tuberculosis. A high level of suspicion is necessary to make this diagnosis, but given an increasing degree of global mobility, such patients may present anywhere. Medical management is effective, though difficult. Early diagnosis improves the patient's individual prognosis and may prevent further exposure and transmission to the population.