Atypical mycobacterial lymphadenitis in childhood - a clinicopathological study of 17 cases

Aims-To assess the clinical and pathological features of atypical mycobacte rial lymphadenitis in childhood to define the salient clinical and histolog ical features. Methods-17 cases were included on the basis of positive cult ure or demonstration of bacilli of appropriate morphology and staining char acteristics. Results-The mean age at diagnosis was 4.86 years. All children were systemically well, with clear chest x rays, Unilateral cervical lymph adenopathy was the commonest mode of presentation, Differential Mantoux tes ting played no part in diagnosis. Clinical diagnosis improved with awarenes s. Treatment varied with surgeons opting for excision and paediatricians ad ding six months antituberculous chemotherapy. Acid- and alcohol-fast bacill i were identified in nine cases. Bacterial cultures were conducted in 16 ca ses and were positive for atypical or nontuberculous mycobacteria in 14, th e main organism being M avium-intracellulare complex (II cases). Histologic ally. 12 cases had bright eosinophilic serpiginous necrosis with nuclear de bris scattered throughout the necrotic foci, Langhans type giant cells feat ured in the majority of cases but infiltration by plasma cells and neutroph ils was not consistent, Conclusions-Atypical mycobacterial lymphadenitis of childhood represents a drare but significant disease with characteristic c linical and histological features.