Non-tuberculous mycobacterial adenitis

Last revised by Daniel J Bell on 27 Nov 2019

Non-tuberculous mycobacterial adenitis refers to lymphadenopathy due to mycobacterial infection other than M. tuberculosis

Most cases occur in immunocompetent children younger than 5 years of age.

Patients present with a firm, painless mass that enlarges over several weeks and develops overlying violaceous skin changes.

The most common microbiologic cause is Mycobacterium avium-intracellulare complex.

The cervicofacial nodes, especially in the submandibular and parotid region, are most commonly involved.

The involved lymph nodes show markedly decreased echogenicity consistent with intranodal liquefactive/cystic necrosis 1. Nodal matting and adjacent soft tissue edema are also present 1.

Contrast-enhanced CT or MRI demonstrates an enlarged nodal mass with central necrosis (rim or heterogeneous enhancement) but characteristically minimal surrounding fat stranding 2-4.

Patients are treated with a combination of surgery (incision and drainage or excision) and antibiotics (for several months), with most achieving cure 4.

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