Atypical mycobacterial tuberculosis--a diagnostic and therapeutic dilemma? Case reports and review of the literature.
In immunocompetent preschool children cervical lymphadenitis is a common clinical presentation of atypical mycobacteria. Its rapid diagnosis and treatment is still a challenge, because accurate diagnostic procedures for atypical mycobacteria are still not yet available in routine practice. Two children suffered from craniojugular (16 months old girl) and infraauricular (2.5 years old boy) located neck masses which showed resistance to the medical treatment. In the first case an abscess splitting took place initially, followed by an anti-tubercular drug treatment and necessary surgical reintervention. In the second case surgical removal of all involved lymph nodes, infiltrated surrounding soft tissue and involved skin areas were followed by medical treatment. In both cases presumed infection with mycobacterium tuberculosis was not confirmed, but atypical mycobacteria could be isolated both. In the first case atypical mycobacterium could be specified as mycobacterium avium complex and in the second case as mycobacterium malmoense. Both bacilli showed sensitivity towards medical treatment with clarithromycin, whereby in one case only the surgical reintervention led to a complete removal of clinical symptomatic. In cases of presumed tuberculous neck lymph node infections differential diagnosis of an atypical mycobacterial lymphadenitis should always be supposed, because medical and surgical treatment differ fundamentally.
Dünne
A A
AA
Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg, Germany.
Kim-Berger
H S
HS
Zimmermann
S
S
Moll
R
R
Lippert
B M
BM
Werner
J A
JA
D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000175:diagnosis / Q000628:therapy; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000628:therapy*; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000302:isolation & purification; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000628:therapy*