Abstract:

Objective: To summarize and analyze the clinical features, imaging findings, pathological characteristics, treatment, and prognosis of nontuberculous mycobacterium (NTM) parotid lymphadenitis in children, with the aim of enhancing the understanding of this condition. Methods: A retrospective analysis was conducted on the clinical data of three children diagnosed with nontuberculous mycobacterium (NTM) parotid lymphadenitis at Guangzhou Chest Hospital between December 2020 and December 2023. The data included general information (age, gender, height, body mass, BCG vaccination history, tuberculosis contact history, etc.), clinical manifestations, laboratory tests, imaging findings, surgical and pathological results, treatment options, and prognosis. A search using the terms ‘non-tuberculous mycobacteria, children, lymphadenitis’ in the PubMed database from 2004 to 2023 retrieved 189 cases. When the search was refined to ‘non-tuberculous mycobacteria, children, lymphadenitis, parotid gland,’ only 5 relevant references were found in PubMed. Additionally, searches using the terms ‘non-tuberculous mycobacterium, children, lymphadenitis’ and ‘non-tuberculous mycobacterium, children, parotid gland’ in the Wanfang and CNKI databases yielded no relevant Chinese literature. A total of 53 and 50 cases, respectively, were reviewed. Results: Of the 53 patients, 32 were male and 21 were female, with an average age of (2.71±1.52)years. The primary clinical manifestation was recurrent neck and facial swelling, typically presenting as painless lymphadenopathy. The duration of illness ranged from 1 month to 1 year. Most patients did not exhibit fever or significant respiratory symptoms such as coughing. Imaging studies, including color Doppler ultrasound, CT, and MRI, revealed parotid gland abscesses. Twenty-five cases tested positive for the tuberculin skin test, and acid-fast staining was positive in pus and lesion tissues in 10 cases. Pathological examination showed chronic granulomatous inflammation. Nucleic acid testing for the nontuberculous mycobacterium complex was positive, while acid-fast staining was negative. Both pus and lesion tissues tested negative for GeneXpert MTB/RIF, and the blood gamma interferon release assay was also negative. After surgical intervention combined with azithromycin, rifampicin, ethambutol, and other anti-infective treatments, the patients recovered without recurrence. Conclusion: When infants present with recurrent unilateral painless enlargement of the parotid gland or preauricular lymph nodes, along with skin discoloration from flushing to violet, and without systemic symptoms such as fever, cough, weight loss, or night sweats, and when conventional antibiotic treatment is ineffective, blood IGRA is negative, and there is no history of active pulmonary tuberculosis, clinicians should be alert to the possibility of NTM parotid gland lymphadenitis. Timely surgical resection combined with appropriate anti-infective therapy is recommended.

Key words: Mycobacterium infections, Child, Lymphadenitis, Parotid gland