“That node” (Nontuberculous mycobacterial facial lymphadenitis)

Abstract

Pediatric infectious diseases specialists and pediatric ear-nose-throat specialists are occasionally referred toddlers-to-3-year-olds with a persisting facial lesion that has baffled their experienced pediatricians. After soliciting a history of wellness and confirming an otherwise normal physical examination, we say “Oh, that node.” This lymph node—always in the subcutaneous space anterior to the masseter and lateral to the angle of the mouth—is the drainage site for the lateral buccal mucosa, lips, and skin of the nose and lower face. Non-tuberculous mycobacteria (NTM) are almost always the cause of chronic enlargement. The lesion has a typical history, characteristic findings, and a course similar to that of NTM submandibular lymphadenitis, although facial lesions are smaller (1-2 cm) and possibly have a higher rate of spontaneous resolution. Facial site, however, raises cosmetic concerns. In this month's issue of The Journal, we publish 7 cases of NTM facial lymphadenitis collected by Haimi-Cohen et al, at a medical center in Tel Aviv, to raise awareness among pediatricians of this uncommon condition, and to allow them one more “see-and-say” diagnosis when they encounter “that node.” Article page 746▸