Abstract
Infection with nontuberculous mycobacteria (NTM) is uncommon in the head and neck; therefore there is no clear consensus on treating these infections. Our objective was to report our experience with a unique case of NTM infection of the parotid in an immunocompetent patient, in order to determine appropriate management through our experience with this pathology. A 57-year-old man, known for numerous comorbid diseases, presented to our institution complaining of right parotid swelling and pain. A computed tomography (CT) of the neck showed a multiloculated collection in the inferior portion of the right parotid gland, compatible with abscess formation. This abscess was drained by interventional radiology (IR) but required repeat drainage twice due to lack of initial improvement. He was treated with several antibiotics as culture results initially indicated Gram-positive bacilli and then Mycobacterium species, with final identification by a reference laboratory as Mycobacterium abscessus. Imipenem was initiated with amikacin and clarithromycin. His infection clinically and radiologically resolved after 5 months of antibiotherapy. In our case, the patient improved following intravenous antibiotic therapy. Our experience demonstrates that appropriate antibiotherapy can lead to resolution of Mycobacterium abscessus infection in the parotid without the risks associated with surgical intervention.
Highlights
Infection with nontuberculous mycobacteria (NTM) is uncommon in the head and neck region, isolating these organisms in the parotid gland is even less common
We describe a case of a Mycobacterium abscessus parotid gland abscess in an immunocompetent, adult patient
We review previous literature describing NTM infections of the parotid gland in order to attempt identification of appropriate management for this pathology
Summary
Infection with nontuberculous mycobacteria (NTM) is uncommon in the head and neck region, isolating these organisms in the parotid gland is even less common. Mycobacteria can be classified into three main groups: the bacteria that cause tuberculosis (M. tuberculosis), the bacteria causing leprosy (M. leprae), and all the others, collectively known as nontuberculous mycobacteria. These organisms most commonly lead to pulmonary disease. We review previous literature describing NTM infections of the parotid gland in order to attempt identification of appropriate management for this pathology. At this time, it is unclear whether surgical intervention or medical management is the preferred treatment modality
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