A Diagnostic Conundrum: Tuberculosis or Salmonella Neck Abscess?

Isaac Yieng Ler Tan1, Hardip Gendeh1, Marina Mat Baki1

  • 1Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.

Cureus
|May 9, 2023
PubMed

Insights

Granulomatous neck abscesses, typically from tuberculosis, can also be caused by Salmonella non-typhi (SN). This report highlights SN as a rare cause of neck granulomas, emphasizing broader differential diagnoses.

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.