Non-tuberculous mycobacterial lymphadenitis mimicking a huge neck metastasis in a 93-year-old male – a rare entity

Introduction The peak incidences of non-tuberculous mycobacterial lymphadenitis (NTML) occur in the first five years of life. Due to its rarity in Germany, the estimated prevalence is not reliable. The surgical removal of the macroscopically affected lymph nodes is not only considered a relevant diagnostic method but also a curative procedure with a full recovery achieved in 92% of the cases.

Methods Case report of a 93-year-old patient with suspected metastatic, capsule-exceeding lymph node conglomerates on the right cervical side. Initially a no-touch panendoscopy with open lymph node biopsy was performed because of a suspected cervical CUP syndrome with a cN3b neck status. Due to the histological and microbiological evidence of NTML, a curative modified radical neck dissection (ND) type I was also performed to definitively rule out a CUP syndrome.

Results Histologically, a necrotizing, epithelioid cell granulomatous lymphadenitis was confirmed, with culture evidence of atypical mycobacteria type M.avium. A complete remission was achieved through the ND. Due to the highly specific findings related to a cervical CUP syndrome, the ND was chosen over alternative therapy options. Thus, in contrast to long-term antibiotic therapy and the wait-and-see procedure, curative treatment and a definitive histological confirmation of NTML could both be ensured at the same time.

Conclusion This case shows that NTML is a relevant differential diagnosis of lymphadenopathy also in adults, with the capability to perfectly mimick a malignant process. In order to accurately differentiate between benign and malignant cervical lymph node diseases, mycobacterial diagnostics often appear to be relevant and therefore should be considered in the diagnostic investigation process.

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Artikel online veröffentlicht:
19. April 2024