title: Pediatric Atypical Mycobacterium Infection Presenting as Wheezing and Concern for Foreign Body Aspiration.
abstract: Atypical mycobacterium infection most commonly presents as asymptomatic cervical lymphadenitis in immunocompetent children. Over the last several decades, rates of Mycobacterium avium complex (MAC) infection have been increasing in both number and severity, with more cases of pulmonary infection reported in healthy children. However, guidelines on how to treat children with these infections remain unclear. The presentation of this disease is variable and often presents with an indolent course of wheezing that is misdiagnosed as foreign body aspiration. Several case reports have described successful treatment of these children with surgical excision without the need for additional treatment with antimycobacterial agents. We present the case of a healthy 20-month old male with wheezing and concern for foreign body ingestion. Rigid bronchoscopy demonstrated a left bronchus mass. The patient underwent video-assisted thoracoscopic surgery (VATS) with improvement in respiratory symptoms. Final pathology showed necrotizing granulomatous infection consistent with MAC. This report demonstrates the importance of keeping intrathoracic MAC infection in the differential when evaluating an immunocompetent child with wheezing or shortness of breath.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center.
authors.forename: Nandini
authors.initials: N
authors.lastname: Govil
authors.affiliation: Michigan Pediatric Ear, Nose and Throat Associates, Children's Hospital of Michigan, Detroit Medical Center.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Department of Pediatric Radiology, Children's Hospital of UPMC.
authors.forename: Darshit J
authors.initials: DJ
authors.lastname: Thakrar
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of UPMC.
authors.forename: David H
authors.initials: DH
authors.lastname: Chi
keywords: differential diagnosis; foreign body aspiration; mycobacterium avium complex; pediatric airway; pediatric otolaryngology