Simultaneous mycobacterial infection of tonsil and cervical lymph node: Evidence to portal of entry

Abstract

Mycobacterial infections are the group of disease caused by Mycobacterium tuberculosis and atypical mycobacterium. Tuberculosis is a systemic disease, which causes common cervical lymphadenitis as extrapulmonary symptoms. Differential diagnosis of atypical mycobacterial infection and tuberculosis by scanning techniques/radiographing imaging, histopathological evaluation and culturing is important due to their different treatments. Most of this systemic disease is curable with antituberculosis therapy. Atypical mycobacteria generally cause local cervical infections. These microorganisms are resistant to the medical therapy, treated by surgical management. In this article, 12-year-old boy admitted with tonsil hypertrophy and unknown bilateral jugulodigastric mass presented. Histopathologic examination of tonsillectomy material was reported as granulomatous inflammation considered primarily tuberculosis and nontuberculosis mycobacterium (NTM). Atypical mycobacteria were isolated from fine needle aspiration biopsy of cervical lymph node. Although antituberculosis regimen had been given to the patient for 18 months, there was no regression in lymphadenopathies. So bilateral selective cervical lymph node dissection was performed and all lymph nodes at this region were excised. There is no recurrence during 3-year follow-up period. The present case showed us, NTM can infect oral cavity and mucosa and spread to cervical area.