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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.
Abstract:
Granulomatous neck abscesses are commonly associated with tuberculosis (TB). These chronic inflammatory reactions are rarely seen in Salmonella non-typhi (SN) infections. We report two cases of SN granuloma presenting as neck abscesses in poultry farmers. TB polymerase chain reactions (PCR) were negative. Histopathology reported necrotizing granulomatous inflammation. Salmonella species are known to cause true granulomas in bone marrow, liver, and spleen. To the best of our knowledge, true granulomas have not been described in cervical lymph nodes. The aim of this report was to highlight the importance of considering other causative microbiological agents in cases of granulomatous neck abscesses. The patients recovered after receiving treatment with surgical drainage and intravenous antibiotics.
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.
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