Mycobacterial infection of the head and neck: Presentation and diagnosis

Objective: To increase the awareness of the different presentations of head and neck mycobacteriosis, especially in apparently immunocompetent patients, and discuss its diagnostic difficulties. Study Design: A retrospective analysis from an otolaryngology service in a university hospital. Methods. Retrospective analysis of head and neck mycobacterial infections diagnosed at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 1983 and 1997. Results: The study group consisted of 75 apparently immunocompetent patients (41 female and 34 male patients). The mean age at presentation was 32.6 years. Mycobacterial cervical lymphadenitis constituted 62 cases (82.7%); pharyngeal tuberculosis, 8 cases (10.7%); and sinonasal disease, 5 cases (6.7%). The presenting complaints were neck mass in 86.3%, nasal obstruction in 5.3%, sore throat or discomfort in 5.3%, and external nasal lesion in 4% of patients. There was a history of previous tuberculosis in 10 patients (13.3%), and 5 patients (6.7%) had history of contact with infected individuals. Constitutional symptoms were recorded in 24 cases (32%). The diagnosis was established on the basis of positive smear in 26.5% of patients and on the basis of positive culture in 33.3% of patients, and caseating granuloma consistent with tuberculosis was found in all patients. Conclusion: The present study is a report of a series of cases of mycobacterial infection of the head and neck in non-immunocompromised patients. It presents diagnostic and therapeutic problems. Awareness of the different presentations, as well as development of modern, efficient diagnostic methods, is required.