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Year : 2014  |  Volume : 59  |  Issue : 1  |  Page : 106
Noncervicofacial atypical mycobacterial lymphadenopathy in a child


1 Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Shebin Elkom, Egypt
2 Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Date of Web Publication23-Dec-2013

Correspondence Address:
Ola Ahmed Bakry
Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Shebin Elkom
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.123550

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How to cite this article:
Seleit I, Bakry OA, El Badawy N, Shehata WA. Noncervicofacial atypical mycobacterial lymphadenopathy in a child. Indian J Dermatol 2014;59:106

How to cite this URL:
Seleit I, Bakry OA, El Badawy N, Shehata WA. Noncervicofacial atypical mycobacterial lymphadenopathy in a child. Indian J Dermatol [serial online] 2014 [cited 2019 Jun 20];59:106. Available from: http://www.e-ijd.org/text.asp?2014/59/1/106/123550


Sir,

Atypical mycobacteria (ATB) are found in environment [1] and are a common cause of superficial lymphadenitis in children. Initially the disease may be mistaken for a staphylococcal or streptococcal abscess. The simple incision and drainage procedures can complicate the management and may result in a poor cosmetic outcome. [2]

A 17-year-old female hailing from a rural region presented with multiple, bilateral, painful inguinal abscesses of 3 years duration [Figure 1]a and b. Lesions were recurrent and progressive. There was a past history of repeated surgical drainage with recurrence. Pencillins and amino glycosides were administered several times but in vain. There was no history of trauma or illness preceding the appearance of lesions.
Figure 1: (a, b) Inguinal abscesses with scars of previous incisions

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General examination was noncontributory. Dermatological examination revealed dusky red, painful, tender, and fluctuant inguinal nodules. The skin all over the body and mucosal surfaces were normal.

Routine laboratory investigations were all normal. Abdomino-pelvic ultrasonography and chest X-ray were free. Culture and sensitivity of the aspirate on ordinary media was sterile.

A biopsy was taken from one representative nodule after taking the patient's consent. Histopathological examination of hematoxylin and eosin-stained section revealed granulomata formed of palisade of epithellioid cells, Langhans giant cells, and histiocytes [Figure 2]. Culture of aspirate on Lwenstein-Jensen media showed positive slow growth of two types of colonies; thin, translucent, cream-colored colonies and domed, opaque, yellow-colored colonies. The diagnosis of Mycobacterium avium-intracellulare-scrofulaceum complex (MAC) was suspected. Polymerase chain reaction (PCR) examination of aspirate confirmed MAC infection. So the diagnosis of ATB lymphadenitis was reached. Azithromycin, rifampicin, and isoniazid were prescribed for 6 months. No new lesions appeared after stoppage of treatment and the case is still under follow up.
Figure 2: Photomicrograph showing dermal nodular granulomata formed of epithelioid cells, Langhans giant cells, and histiocytes (H and E, ×100)

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Infection with ATB is a well-known cause of peripheral lymphadenitis in children. Several studies have reported a rising incidence in the Western world. [2] The disease is common especially in rural areas and in the tropics with slight predominance in females. [3] The majority of cases have involved cervicofacial lymph nodes. [2]

The relative infrequency of inguinal lymphadenopathy makes early clinical diagnosis difficult. The diagnosis should be considered in light of a history of previous trauma, several weeks or even months earlier, followed by the development of regional lymphadenitis in a child in whom there is no record of contact with a cat. MAC was reported to be responsible for 68% of cases of noncervicofacial ATB lymphadenitis in children. [4]

The most effective treatment remains the complete local excision. [5] Incision and drainage are associated with a high recurrence rate and a higher rate of complications such as fistula, and excessive scarring. [6] If complete excision of affected lymph nodes is performed as the first surgical procedure, there is an excellent prognosis of healing without requiring antimycobacterial medication after operation. [7]

The German association for Paediatric Infectious Diseases (DGPI) recommends a course of antimycobacterial drugs for 6-12 months (e.g., clarithromycin, ethambutol, and rifampicin) if complete excision is not performed as the first step. The development of resistance has been documented on monotherapy, and The use of at least two agents is now recommended. [8]

We report a case of ATB inguinal lymphadenopathy owing to its rarity.

 
   References Top

1.Handa S, Sharma VK. Atypical mycobacterial infections mimicking mycetoma. Indian J Dermatol 1993;38:74-7.  Back to cited text no. 1
  Medknow Journal  
2.Kuth G, Lamprecht J, Haase G. Cervical lymphadenitis due to mycobacteria other than tuberculosis-an emerging problem in children? ORL J Otorhinolaryngol Relat Spec 1995;57:36-8.  Back to cited text no. 2
[PUBMED]    
3.Nylén O, Berg-Kelly K, Andersson B. Cervical lymph node infection s with non-tuberculous mycobacteria in preschool children: Interferon gamma deficiency as a possible cause of clinical infection. Acta Paediatr 2000;89:1322-5.  Back to cited text no. 3
    
4.Holland AJ, Holland J, Martin HC, Cummins G, Cooke-Yarborough C, Cass DT. Noncervicofacial atypical mycobacterial lymphadenitis in childhood. J Pediatr Surg 2001;36:1337-40.  Back to cited text no. 4
[PUBMED]    
5.Bodenstein L, Altman RP. Cervical lymphadenitis in infants and children. Semin Pediatr Surg 1994;3:134-41.  Back to cited text no. 5
[PUBMED]    
6.Lindeboom JA, Smets AM, Kuijper EJ, van Rijn RR, Prins JM. The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol 2006;36:1063-7.  Back to cited text no. 6
[PUBMED]    
7.Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, Lindeboom R, Prins JM. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: A multicenter, randomized, controlled trial. Clin Infect Dis 2007;44:1057-64.  Back to cited text no. 7
[PUBMED]    
8.DG Handbuch. Therapie der NTM Infektionen. Stuttgart: Georg Thieme Verlag; 2009. p. 542.  Back to cited text no. 8
    


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