Non-tuberculous mycobacterial cervical lymphadenitis in the immunocompetent child: diagnostic and treatment approach

Non-tuberculous mycobacterial disease in the otherwise well child commonly presents as a localized, slow-progressing, cervicofacial lymphadenopathy. Despite recent advances, several aspects of the susceptibility to and the course of the disease remain to be better understood, and diagnosis and management of non-tuberculous mycobacterial lymphadenitis in children are often controversial. Differential diagnosis should include other infections, in particular tuberculosis, local cysts and malignancies. In the majority of cases, untreated disease progresses to spontaneous drainage, fistula formation and scarring and a high index of clinical suspicion is necessary for timely diagnosis and treatment. Excisional surgery seems to remain the gold standard. Medical treatment might be considered as an appropriate alternative in case there is a high risk of surgical complications or in case surgery has already been unsuccessful. Family reassurance and the watch-and-wait approach may be an option in milder disease.