A Diagnostic Conundrum: Tuberculosis or Salmonella Neck Abscess?

Area of Science:

• Infectious Diseases
• Microbiology
• Pathology

Background:

• Granulomatous neck abscesses are predominantly linked to Mycobacterium tuberculosis (TB).
• Chronic inflammatory reactions manifesting as granulomas are infrequently associated with Salmonella non-typhi (SN) infections.

Observation:

• Two poultry farmers presented with neck abscesses due to SN granulomas.
• Tuberculosis polymerase chain reaction (PCR) tests were negative for both patients.
• Histopathology revealed necrotizing granulomatous inflammation.

Findings:

• Salmonella species are recognized to induce true granulomas in organs like bone marrow, liver, and spleen.
• This case series describes, for the first time, true granulomas in cervical lymph nodes caused by SN.
• The patients demonstrated recovery following surgical drainage and intravenous antibiotic therapy.

Implications:

• Clinicians should consider non-tuberculous pathogens, such as Salmonella non-typhi, in the differential diagnosis of granulomatous neck abscesses.
• This finding expands the understanding of Salmonella's potential to cause granulomatous inflammation in lymph nodes.
• Early identification and appropriate antibiotic treatment are crucial for managing SN-induced granulomatous neck abscesses.