Mycobacterial Lymphadenitis Research Articles

Lymphadenitis due to non-tuberculous mycobacteria: Experience over 15 years

Abstract Objective To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragon (Spain). Material and methods A retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. Inclusion criteria: patients with lymphadenitis and positive culture. Quantitative values are shown as mean, rank, and standard deviation, and qualitative data as frequencies. Results Twenty-seven cases were registered, with a mean age of presentation of 39.9 months (range 10 months–8 years). The mean time between the symptoms onset and first consultation was 1.7 ± 1.1 months. The most frequent location was sub-maxilar in 17/27 cases (63%), on the right side in 59.3%, and size 2.96 ± 1.26 cm. Fistulae were observed in 16/27 cases. Tuberculin test was greater than 10 mm in 7/24 (29.1%). Microbiological cultures were positive for Mycobacterium avium in 14/27 (51.9%), Mycobacterium intracellulare 3/27 (11.1%), and Mycobacterium lentiflavum 3/27 (11.1%). Combined treatment of antibiotics and surgery was given in 16/27 cases (59.8%), medical treatment only in 7/27 (25.9%), and surgical exeresis alone in 4/27 (14.8%). Two patients required a new surgery, and one showed severe neutropenia secondary to rifabutin. Only one case (3.7%) suffered from temporary facial palsy as sequel. Conclusions The most frequent treatment was the combination of antibiotics and surgery. Delay in diagnosis seemed to be responsible for the limited number of exeresis as first option, only one for every seven patients.

Treatment outcome in children with nontuberculous mycobacterial lymphadenitis: A retrospective follow-up study.

Information on the long-term treatment outcome following nontuberculous mycobacterial (NTM) lymphadenitis is very limited. We performed a study to (a) compare cure rates following different initial treatment courses, (b) describe subsequent treatment courses and their outcomes, and (c) determine the occurrence of late sequelae in immunocompetent children with NTM lymphadenitis. In 2011, we conducted a retrospective follow-up study in 71 parents whose children had been hospitalized with NTM disease 2002-2005. A telephone survey was performed using a standardized questionnaire to collect information on the therapeutic management and treatment outcome. Of 61 children with NTM lymphadenitis, 33 (54%) children were cured after the initial treatment. We found no significant difference in cure rates following surgical intervention only (45%, 13/29 children) and a combination of surgical intervention and chemotherapy (61%, 19/31 children). In 7 out of 11 children, the cure rate following complete lymph node excision was 64%. Subsequent courses of treatment including repeated surgical intervention, combination therapy, chemotherapy only, and wait-and-see strategy in children where initial therapy failed resulted in the cure of all 61 children. In four children (7%), recurrences were observed up to 5 years later. Our study showed that recurrent NTM lymphadenitis might be observed several years after initial resolution of disease. The cure rate following complete lymph node excision was lower than reported in other studies. Subsequent treatment courses were necessary in half of the children. Physicians and parents need to be aware that NTM lymphadenitis in children requires careful choice of intervention and active follow-up.

Management of nontuberculous mycobacterial lymphadenitis in a tertiary care children's hospital: A 20 year experience

PurposeNontuberculous mycobacteria are uncommon cause of chronic cervicofacial lymphadenitis in healthy children. We describe clinical features and management strategies of cervicofacial nontuberculous mycobacterium lymphadenitis in a tertiary pediatric hospital. MethodsRetrospective analysis of medical records of children discharged from 1992 to 2014 with a diagnosis of cervicofacial nontuberculous mycobacterium was made. Diagnosis certainty was based on microhistological investigations. Clinical stage was evaluated according to lymph node size and presence of fistulas. Successful therapy was defined by the regression of the lymph node enlargement (>75%) or complete surgical excision without relapse. ResultsCervicofacial nontuberculous mycobacterium was diagnosed in 33 patients. Complete excision was performed in 73% of cases primarily observed in our hospital, while 83% of those referred from other hospitals required further surgical treatment. No case of relapse was observed after one year of follow-up. ConclusionsWe recommend surgical approach as the first therapeutic option in the management of cervicofacial nontuberculous mycobacterium lymphadenitis.Levels of Evidence: Prognosis and Retrospective Study — Level II.

Atypical Mycobacterial Lymphadenitis in the Head and Neck of Pediatric Patients

Atypical Mycobacterial Lymphadenitis in the Head and Neck of Pediatric Patients

Long-term Follow-up of Observation-Only Management of Nontuberculous Mycobacterial Lymphadenitis.

A total of 21 children with clinically and microbiologically proven craniofacial nontuberculous mycobacterial lymphadenitis managed by observation only at a tertiary medical center in 1993-2005 were evaluated for scar parameters at least 2 years after diagnosis. Parents completed a satisfaction questionnaire. Median follow-up time from presentation was 6.8 years (range = 2.3-16.9 years). In all, 18 patients showed scar formation, for a total of 26 scars; 21 scars (81%) had a maximal length of ≤3 cm. Vascularity was normal in 20 scars (77%), and pigmentation was normal in 18 (69%); 21 scars (81%) had a normal to only mildly uneven surface. Although 8 parents (44%) reported that the presence of the scar disturbed them, all responders but one (94%) expressed overall contentment of observation only as a conceivable management alternative. In conclusion, an observation-only approach to craniofacial nontuberculous mycobacterial lymphadenitis is associated with an acceptable outcome and may be an alternative to patients who wish to avoid surgery.

Linfadenitis por micobacterias no tuberculosas: experiencia de 15 años

ObjectiveTo study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain). Material and methodsA retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. Inclusion criteria: patients with lymphadenitis and positive culture. Quantitative values are shown as mean, rank, and standard deviation, and qualitative data as frequencies. ResultsTwenty-seven cases were registered, with a mean age of presentation of 39.9 months (range 10 months–8 years). The mean time between the symptoms onset and first consultation was 1.7±1.1 months. The most frequent location was sub-maxilar in 17/27 cases (63%), on the right side in 59.3%, and size 2.96±1.26cm. Fistulae were observed in 16/27 cases. Tuberculin test was greater than 10mm in 7/24 (29.1%). Microbiological cultures were positive for Mycobacterium avium in 14/27 (51.9%), Mycobacterium intracellulare 3/27 (11.1%), and Mycobacterium lentiflavum 3/27 (11.1%). Combined treatment of antibiotics and surgery was given in 16/27 cases (59.8%), medical treatment only in7/27 (25.9%), and surgical exeresis alone in 4/27 (14.8%). Two patients required a new surgery, and one showed severe neutropenia secondary to rifabutin. Only one case (3.7%) suffered from temporary facial palsy as sequel. ConclusionsThe most frequent treatment was the combination of antibiotics and surgery. Delay in diagnosis seemed to be responsible for the limited number of exeresis as first option, only one for every seven patients.

Elispot Igra With Purified Protein Derivative Stimulation For Diagnosing Nontuberculous Mycobacterial Cervical Lympadenitis.

Childhood cervical lymphadenitis caused by nontuberculous mycobacteria is a diagnostic challenge for the clinician. We present a new promising diagnostic method for childhood nontuberculous mycobacterial lymphadenitis. The modified T-SPOT.TB test with purified protein derivative as an additional antigen is noninvasive with estimated sensitivity and specificity of 1.00 and 0.81, respectively.

Adenitis due to nontuberculous mycobacteria: Which is the best treatment?

The aim of this study is to study the management and evolution of nontuberculous mycobacterial lymphadenitis and to analyze different therapeutic options. A retrospective study was performed on patients under 14 years diagnosed from 1987 to 2004 in a tertiary care children's hospital. Inclusion criteria were: (1) Positive polymerase chain reaction or culture. (2) Histopathological features compatible with mycobacterial infection and/or positive direct smear for acid-fast bacilli and sensitive skin test 6 mm above Mantoux. (3) Histopathological features compatible with mycobacterial infection and/or positive direct smear for acid-fast bacilli, Mantoux reaction less than 15 mm and absence of risk factors for tuberculous infection. In order to analyze the effectiveness of the different therapeutic options, we divided our patients into 4 groups, based on the initial treatment received: Group 1 antibiotics alone (n = 21), Group 2 drainage (n = 13), Group 3 excision (n = 8) and Group 4 no treatment (n = 6). Fifty-four patients were included. Therapy failed in 38% of patients receiving antibiotics (n = 8), in 77% of patients with drainage alone (n = 10) and in none of the patients who underwent surgery. Healing time was shortest in patients undergoing surgery. Sinus formation occurred either spontaneously (66.6%) or despite the medical treatment (57%) or drainage (53%). No patients developed fistulas after surgical excision. Transient paresis of the mandibular branch of the facial nerve occurred in three patients (13%) after complete excision. Some nontuberculous adenitis respond to medical treatment alone, but complete surgical excision remains the most effective treatment, obtaining an early definitive healing. Transient mandibular nerve paresis was the main complication observed in the excision group.

Mycobacterial cervicofacial lymphadenitis in human immunodeficiency virus-infected individuals after antiretroviral therapy initiation.

Mycobacterial infections are the leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals worldwide. Cervical lymph nodes are the most frequently affected extrapulmonary sites. Despite the substantial reduction in complications of HIV-tuberculosis coinfection, a proportion of individuals develop immune reconstitution inflammatory syndrome (IRIS), a term used for a clinical deterioration following initiation of antiretroviral therapy (ART). The objective of this study was to describe mycobacterial-associated IRIS in cervical lymph nodes of HIV-infected individuals receiving ART. Retrospective cohort study, set in a tertiary referral center in Mexico City. We included ART-naive subjects who had at least one follow-up ear, nose, and throat examination, and were diagnosed with lymph node mycobacterial infection before or during the first 3 months of ART initiation. Mycobacterial-associated IRIS in cervical lymph nodes was determined retrospectively through clinical case definition and medical chart review. Thirty-three subjects who initiated ART were diagnosed with cervical lymph node mycobacteriosis; 24 had Mycobacterium tuberculosis infection and nine had nontuberculous disease. M. tuberculosis was the most common pathogen isolated from cervical lymph nodes. The only factor associated with IRIS was infection with a nontuberculous mycobacteria. The unexpectedly high incidence of mycobacterial-associated IRIS underlines the relevance of head and neck examination before ART initiation. 4.

Herpes simplex lymphadenitis in association with chronic lymphocytic leukaemia

Herpes simplex lymphadenitis is a rare condition that is most commonly seen in immunocompromised patients. To date, less than 30 cases have been reported in the literature. It is most commonly seen in patients with haematological malignancy, especially with chronic lymphocytic leukaemia. However, it can be associated with other neoplasms such as Hodgkin lymphoma, mantle and marginal zone B-cell lymphoma, acute and chronic myeloid leukaemia. Presentation can be varied from localised lymphadenopathy, generalised lymphadenopathy with or without a rash, and disseminated HSV infection with multiple organ involvement. Histologically, it shows areas of coalescing necrosis and inflammatory cell infiltrates including histiocytes and neutrophils. Multinucleate cells with ground glass nuclei and Cowdry type A intranuclear inclusions are diagnostic; the diagnosis can be confirmed with herpes simplex virus in-situ hybridisation or immunohistochemistry. Differential diagnoses to consider include cat scratch lymphadenitis, mycobacterial tuberculosis lymphadenitis, Kikuchi-Fujimoto lymphadenitis, systemic lupus erythematosus, Hodgkin lymphoma and large cell non-Hodgkin lymphoma. Herpes simplex lymphadenitis is an important diagnosis which can mimic transformation of an underlying haematological malignancy. We present a case of a 68-year-old male with localised lymphadenopathy and history of chronic lymphocytic leukaemia.

Rapid diagnosis of pediatric mycobacterial lymphadenitis using fine needle aspiration biopsy.

Diagnosis of tuberculosis in children is challenging and fine needle aspiration biopsy (FNAB) is used worldwide in the diagnosis of palpable masses including peripheral lymphadenopathy. Recent studies of the use of nucleic acid amplification such as the Xpert MTB/RIF test on FNAB in adult patients have shown considerable promise. Xpert MTB/RIF allows for the rapid diagnosis of Mycobacterium tuberculosis and identification of rifampicin susceptibility. Studies to date have been predominantly performed in adults. This study aims to determine the accuracy of Xpert MTB/RIF for the detection of M. tuberculosis complex in FNAB from children with clinically suspected mycobacterial lymphadenitis. Prospective hospital-based study of children <13 years referred for FNAB at Tygerberg hospital and Dora Nginza hospital, South Africa, for suspected mycobacterial lymphadenitis. Aspirates were performed and the results of the Xpert MTB/RIF test were compared with liquid (mycobacterial growth indicator tube) culture and cytology. FNABs were collected from 110 children and 38 (35%) cases were excluded. Of the 72 cases included in the study, 32 were positive for M. tuberculosis complex on Xpert MTB/RIF, 36 on cytology and 25 were culture positive for M. tuberculosis complex. Compared with the combined reference standard (cytomorphology suggestive of mycobacterial disease with direct visualization of the organism and/or bacteriological culture), Xpert MTB/RIF identified 32 of 40 cases as positive with a sensitivity and a specificity of 80% and 93.8%, respectively. FNAB and Xpert MTB/RIF enable a rapid diagnosis in pediatric mycobacterial lymphadenitis, expediting appropriate treatment and potentially preventing morbidity and mortality.

Use of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) in the Diagnosis of Granulomatous Mediastinal Lymphadenopathy

This study assessed the clinical utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of suspected granulomatous mediastinal lymphadenopathy. Retrospective chart review of all patients who underwent EBUS-TBNA for suspected granulomatous mediastinal lymphadenopathy at Singapore General Hospital between December 2008 and December 2011 inclusive. Over a period of 3 years, a total of 371 patients underwent EBUS-TBNA of whom 33 (9%) had the procedure performed for evaluation of suspected granulomatous mediastinal lymphadenopathy - 18 for suspected tuberculosis (TB) and non-tuberculous mycobacterial (NTM) lymphadenitis, and 15 for suspected sarcoidosis. EBUS-TBNA was diagnostic in 9 of the 13 patients with a final diagnosis of TB/NTM. EBUS-TBNA cultures were positive in 6 of them (46%), 1 showed acid-fast bacilli (AFB) although cultures were negative, and 2 had necrotising granulomatous inflammation from EBUS-TBNA biopsies and sputum cultures grew TB. EBUS-TBNA was diagnostic in 9 of the 14 patients with a final diagnosis of sarcoidosis through histology showing non-caseating granulomatous inflammation. The sensitivities of EBUS-TBNA for diagnosis of TB/NTM, sarcoidosis and overall granulomatous mediastinal lymphadenopathy were 69%, 64%, 64%; the negative predictive values were 56%, 17%, 33%; and accuracies were 78%, 67%, 70%, respectively. EBUS-TBNA can be useful in the diagnosis of suspected granulomatous mediastinal lymphadenopathy with sensitivities and accuracies of >60%.

Diagnostic yield of fine needle aspiration biopsy in HIV-infected adults with suspected mycobacterial lymphadenitis

Fine needle aspiration biopsy (FNAB) has been shown to be the diagnostic procedure of choice for superficial lymphadenitis in tuberculosis endemic regions. We conducted a retrospective laboratory-based study to determine the bacteriological yield of clinically suspected mycobacterial tuberculous lymphadenitis following FNAB in adults, and specifically HIV-positive patients, to determine the need for the introduction of automated nucleic acid amplification tests (NAATs) such as the Xpert MTB/RIF assay as the initial diagnostic modality. RESULTS. A diagnostic yield of 80% was achieved, significantly higher in HIV-positive v. HIV-negative patients (84% v. 52%, respectively; p<0.001). The results justify using automated NAATs such as the Xpert MTB/RIF assay as the initial diagnostic modality to expedite management in HIV-infected patients.

Histology of solid lateral cervical masses biopsied in children

IntroductionSolid cervical lateral neck masses in children may require surgical biopsy to confirm appropriate diagnostic and begin a directed therapeutic treatment. We aimed to describe the contribution of pathological results and compare them with the clinical diagnosis and the paraclinical tools. MethodsA retrospective review of surgical biopsies for solid lateral neck masses in children over a ten year period in a pediatric tertiary center was conducted. Demographic, imaging, laboratory analysis, surgical and pathological data were collected and analyzed using descriptive statistics with SPSS 17.0. Results44 biopsies were done between 2002 and 2012. Inflammatory masses were found in 26/44 biopsies with half of them (13/26) being nontuberculous mycobacterial (NTM) lymphadenitis. Non-inflammatory/benign masses represented 9/44 biopsies and 5/44 masses were of malignant etiology. Malignant masses imaging had a sensitivity and specificity of 33% and 75%, respectively, for ultrasound, whereas Neck CT scan had 33% and 77%, respectively. The contribution of pathological results to the clinical management was questionable in 39% (17/44) of biopsies. ConclusionInflammatory masses with NTM lymphadenitis were the most common diagnosis. Imaging was not helpful in establishing the diagnosis. Heterogeneity in the management of solid lateral neck masses between clinicians was important and indicates the need for guideline approach.

Mannose-binding Lectin Gene Polymorphisms and Mycobacterial Lymphadenitis in Young Patients

Tuberculosis (TB) has recently re-emerged as a major public health threat worldwide. There is strong evidence that host genetic factors influence individual susceptibility to TB and that, once infected, young children and immunocompromised patients are at increased risk for mycobacterial disease and progression to extrapulmonary lymphadenitis. The association between polymorphisms of mannose-binding lectin and the susceptibility of 139 children with cervical mycobacterial lymphadenitis and infected with Mycobacterium tuberculosis was investigated. The frequencies of genotypes A/B and B/B, based on codon 54 polymorphisms, were significantly different in TB-infected versus healthy control subjects. The frequency of the A/B genotype was significantly lower in TB-infected children (odds ratio = 0.56; 95% confidence interval: 0.36-0.87; P = 0.01), and the B/B genotype was significantly higher in TB-infected children (odds ratio = 4.68; 95% confidence interval: 1.35-16.3; P = 0.01) compared with healthy controls. The HYB haplotype appeared significantly more often to be protective in the healthy control population (odds ratio = 0.23; 95% confidence interval: 0.05-0.96; P = 0.046). Ex vitro phagocytosis assays indicated that high-expression mannose-binding lectin genotypes are associated with an increased risk of infection with M. tuberculosis. The present study suggests that mannose-binding lectin can protect against TB or predispose the host to the disease depending on the haplotype pair of the host. The low-expression genotype A/B and the HYB haplotype may be associated with protection against intracellular mycobacterial infections, whereas the high-expression genotype A/A may confer susceptibility to disease.

Predicting Surgical Outcomes in Pediatric Cervicofacial Nontuberculous Mycobacterial Lymphadenitis

We examined surgical outcomes in children with cervicofacial nontuberculous mycobacterial lymphadenitis and attempted to identify predictors of complications. A retrospective chart review from 2 tertiary pediatric centers was used to identify .11 presentation or operative variables (age at surgery, gender, symptom duration, pain, violaceous skin changes, skin breakdown, fluctuance, purified protein derivative positivity, operative procedure, use of nerve integrity monitoring, and use of skin flap advancement) and to compare these to 5 postoperative complications (facial nerve dysfunction [paresis or paralysis], poor scarring, recurrence, wound infection, and wound dehiscence without infection). The 45 patients analyzed for presentation or operative variables (28 female, 17 male; average age, 31.2 months) typically presented with painless masses averaging 8.2 weeks in duration, along with violaceous skin changes in 29 of the 45 cases (64%) and skin breakdown in 9 cases (20%). The surgical procedures included parotidectomy with or without selective lymphadenectomy in 38 of the 45 cases (84%) and lymphadenectomy alone in 7 cases (16%). Skin resection and cervicofacial advancement flap reconstruction was performed in 20 cases (44%). Nerve integrity monitoring was utilized in 32 cases (71%). In the 44 patients analyzed for postoperative complications, we found facial nerve paresis in 14 (31.8%), poor scarring in 9 (20.5%), wound infection in 6 (13.6%), recurrence in 4 (9.1%), and facial nerve paralysis in 2 (4.5%). Nine of the 14 cases (64.3%) of initial facial nerve paresis resolved. At final follow-up, facial nerve paresis persisted in 5 of the 14 children (35.7%) with initial postoperative paresis and in 1 of the 2 children (50.0%) with initial postoperative paralysis. Facial nerve paralysis persisted in the other child with initial postoperative paralysis. Overall, 6 of these 7 patients (85.7%) with persistent facial nerve dysfunction had follow-up of less than 1 month. All transient and permanent facial nerve dysfunction was in the distribution of the marginal mandibular nerve only. No statistically significant predictors of complications were identified. We report acceptable but not insignificant rates of marginal mandibular distribution facial nerve injury, poor scarring, wound infection, and recurrence following resection of cervicofacial nontuberculous mycobacterial lymphadenitis in children that must be discussed with patients and parents before operation. No presentation or operative variables predicted the complications.

Mainstem to Mainstem Bronchial Fistula from Broncholithiasis

Broncholithiasis is a rare condition in which calcified material erodes into the tracheobronchial tree. Most are caused from a fungal, nocardial, mycobacterial, or silicosis-related granulomatous lymphadenitis. Over time, the peribronchial lymph nodes become calcified; thereafter, with the normal repetitive motions of respiration, circulation, and deglutition, the calcifications erode into the lumen of the airway. This condition can be challenging to diagnose as its symptoms can mimic many more common diseases. The most common symptoms are wheezing, chronic cough, and dyspnea; thus, it was previously referred to as "stone asthma." More devastating complications can include massive hemoptysis, recurrent pneumonias, bronchiectasis, mediastinal abscess, and fistula formations. Only airways to mediastinal, esophageal, or vascular fistulas have been reported in the literature. This is the first reported case of a patient treated with electrocautery forceps, who developed a mainstem to mainstem bronchial fistula.

Cervical Nontuberculous Mycobacterial Lymphadenitis Mimicking a Thyroid Tumor and Infiltrating Deep into the Neck

Aim: Nontuberculous Mycobacterial Lymphadenitis (NML), which occurs in 1.2 per 100,000 children, is very rare. And those which emerge at the anterior cervical portion and infiltrate deep into the neck are even more rare. Generally, this disorder is uncommon existed near the thyroid gland. We report here a case of NML mimicking a thyroid tumor and infiltrating into the deep part of the anterior neck. Case: A mass at the anterior portion of her neck was found at 5 years old. It was not mobile and palpated as an irregularly surfaced hard mass whose size was 3 cm at the anterior lower portion of her neck. Ultrasonography showed an oval mass which existed near the slightly inferior part of the right lobe of the thyroid gland. Enhanced computed tomography showed a mass near the slightly inferior part of the right lobe of the thyroid gland. The mass was resected with the platysma and the right sternohyoid muscle. In the HE staining, epithelioid cell and Langhans type giant cells surrounding coagulative necrosis lesions which seemed to be caseation necrosis existed, similarly to cervical NML. Discussion: No consensus exists for the treatment of NML, but many documents advise complete excision. When the lesion cannot be completely removed, excision as far as possible and additional antibiotics are recommended. The characteristics of imaging of NML around the thyroid gland and infiltrating deep into the anterior neck and mediastinum are discussed.

Internal jugular vein erosion: An aggressive presentation of non-tuberculous mycobacterial lymphadenitis

Abstract We report the unusual case of a 2-year-old boy with non-tuberculous mycobacterial lymphadenitis that eroded into his internal jugular vein. During neck dissection, internal jugular vein erosion and mismatch in vessel width were noticed. Approximately 1 cm of internal jugular vein was resected and end-to-end anastomosis was performed. Four months later the patient had a relapse requiring a second operation. Despite the reported increased incidence of non-tuberculous mycobacterial lymphadenitis in immunocompetent patients, there are no other cases of internal jugular vein erosion reported in the literature. The approach in dealing with this condition is described.

Nontuberculous mycobacterial cervicofacial lymphadenitis—A review and proposed classification system

Objective To describe a clinical staging system for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis that has both diagnostic and therapeutic implications. Methods A Medline database search was performed using key words “nontuberculous mycobacteria”. All articles pertaining to nontuberculous mycobacterial cervicofacial lymphadenitis were reviewed for data evaluation regarding diagnosis and treatment methodologies. Results Nontuberculous cervicofacial lymphadenitis infections pass through distinctly segmented clinical phases. In Stage I, a painless mass presents with notable increase in vascularity. Stage II is characterized by liquefaction of the affected lymph node, causing the mass to appear fluctuant. Significant skin changes characterize Stage III, whereby overlying skin may develop violaceous discoloration and become notably thinner, or parchment-like, with a “shiny” appearance. During Stage IV, the lesion fistulizes to the skin surface causing a draining wound. Conclusions While nontuberculous mycobacterial cervicofacial lymphadenitis has typically been thought of as a surgical disease, further characterization is warranted. We present a new classification system for appraising the clinical stages of nontuberculous mycobacterial cervicofacial lymphadenitis that may be used as part of a greater approach to disease management: (1) after other causes have been ruled out, the possibility of a tuberculous scrofula must be eliminated, and the degree of diagnostic suspicion must be categorized; (2) the clinical stage of the infection can be determined using the classification system described; and (3) a stage-specific treatment may be chosen based on the individual patient.