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NTM lymphadenitis — RACP Paediatrics MCQ

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ModerateIDNTM lymphadenitisRACP Paediatrics

A 2-year-old presents with a unilateral non-tender submandibular lymph node (3 cm) that has slowly enlarged over 6 weeks. The overlying skin has a violaceous discolouration. The child is well with no systemic symptoms. Mantoux test is 8 mm. What is the most likely diagnosis?

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Correct answer: A — Mycobacterial lymphadenitis (NTM)

Slowly enlarging unilateral cervicofacial lymphadenopathy with violaceous skin discolouration in a well preschool child is characteristic of non-tuberculous mycobacterial (NTM) lymphadenitis. Mantoux may be weakly positive (5-14 mm). Complete surgical excision is the recommended treatment rather than incision and drainage.

Reference: RCH Melbourne – 2023 – Cervical Lymphadenopathy CPG; Australian Therapeutic Guidelines – 2024 – Antibiotic