# Nontuberculous Mycobacteriosis as a Cause of Cervical Lymphadenopathy: A Retrospective Case Series

## TL;DR

This study examines nontuberculous mycobacteria causing neck lymph node swelling, focusing on diagnosis and treatment in children.

## Contribution

The study provides insights into the clinical management and outcomes of NTM-associated cervical lymphadenopathy in a tertiary care setting.

## Key findings

- Most patients were children from rural areas with median age of 1 year.
- Antibiotic therapy with clarithromycin and rifampicin led to regression in most cases within six months.
- Microbiological confirmation was achieved in 64% of cases using cultures.

## Abstract

Background: The global incidence of infections caused by nontuberculous mycobacteria (NTM), environmental pathogens commonly found in soil and water, is increasing. Among the various NTM species, Mycobacterium avium is most frequently implicated. Clinical manifestations are diverse and include chronic pulmonary disease, disseminated infection, and cervical lymphadenopathy, particularly in children. This study aimed to evaluate the diagnosis and treatment of NTM-associated cervical lymphadenopathy at a tertiary referral center. Methods: All patients treated for NTM-associated cervical lymphadenopathy at the Department of Otorhinolaryngology, Medical University of Innsbruck, between 2010 and 2024 were retrospectively analyzed. Demographic data, imaging findings, microbiological results, therapy, and follow-up were evaluated. Results: A total of 22 patients with a median age of 1 (IQR 2) year were identified, most of whom originated from rural areas (91%). Diagnosis was based on characteristic clinical and imaging findings. Cervical ultrasonography was performed in all patients, and additional magnetic resonance imaging was performed in 55%. Microbiological confirmation was achieved in 64% of cases using liquid or solid cultures, while no pathogen was detected in 36%. Treatment consisted of combined antibiotic therapy with clarithromycin and rifampicin for 3–6 months, with additional surgical intervention in selected cases. Follow-up demonstrated clear regression of lymphadenopathy in the majority of patients within six months. Conclusions: NTM infection should be considered in the differential diagnosis of cervical lymphadenopathy. Pathogen detection remains challenging, and antimicrobial therapy alone may be sufficient in selected cases.