Mycobacterial infection of the head and neck: presentation and diagnosis

To increase the awareness of the different presentations of head and neck mycobacteriosis, especially in apparently immunocompetent patients, and discuss its diagnostic difficulties.

A retrospective analysis from an otolaryngology service in a university hospital.

Retrospective analysis of head and neck mycobacterial infections diagnosed at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 1983 and 1997.

The study group consisted of 75 apparently immunocompetent patients (41 female and 34 male patients). The mean age at presentation was 32.6 years. Mycobacterial cervical lymphadenitis constituted 62 cases (82.7%); pharyngeal tuberculosis, 8 cases (10.7%); and sinonasal disease, 5 cases (6.7%). The presenting complaints were neck mass in 86.3%, nasal obstruction in 5.3%, sore throat or discomfort in 5.3%, and external nasal lesion in 4% of patients. There was a history of previous tuberculosis in 10 patients (13.3%), and 5 patients (6.7%) had history of contact with infected individuals. Constitutional symptoms were recorded in 24 cases (32%). The diagnosis was established on the basis of positive smear in 26.5% of patients and on the basis of positive culture in 33.3% of patients, and caseating granuloma consistent with tuberculosis was found in all patients.

The present study is a report of a series of cases of mycobacterial infection of the head and neck in non-immunocompromised patients. It presents diagnostic and therapeutic problems. Awareness of the different presentations, as well as development of modern, efficient diagnostic methods, is required.