Atypical Mycobacterial Lymphadenitis

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After 3 months of seeing this painless mass at the angle of the 3-year-old's left jaw, his parents sought medical advice for their son. The youngster had no constitutional symptoms. A Mantoux test was performed, and an erythematous, indurated area measuring 15 mm in diameter was found at the test site 48 hours later.

After 3 months of seeing this painless mass at the angle of the 3-year-old's left jaw, his parents sought medical advice for their son. The youngster had no constitutional symptoms. A Mantoux test was performed, and an erythematous, indurated area measuring 15 mm in diameter was found at the test site 48 hours later. A biopsy of the mass revealed lymphoid tissue with obliteration of the normal architecture by a granulomatous inflammation. Some of the granulomas showed caseous necrosis. The lymph node was excised. Culture of the excised tissue yielded Mycobacterium scrofulaceum. The child was given rifampicin and ethambutol and had an uneventful recovery.

Drs Alexander K. C. Leung and Helen Y. H. Cho of Calgary, Alberta, write that unlike M tuberculosis, the lymphadenopathy caused by atypical mycobacteria is usually unilateral and frequently involves lymph nodes at the angle of the jaw.1 In both mycobacterial and atypical mycobacterial lymphadenitis, the overlying skin is not warm to the touch; it often is referred to as “cold” inflammation.

REFERENCE:
1. Leung AK, Robson WL. Cervical lymphadenopathy in children. Can J Pediatr. 1991;3(2):10-17.