A 2-year-old boy, previously healthy and with no history of interest, consulted for a right submandibular adenopathy of ten weeks duration as the only symptom, without response to antimicrobial treatment with amoxicillin and clavulanic acid.
On physical examination, adenopathy was 2 x 2 cm in size, non-adherent, with slight fluctuation and adjacent erythematous-violaceous skin; the rest of the examination was normal.
The markers of infection and inflammation and serology for Epstein's syndrome, syphilis, toxoplasma, cytomegalovirus and Bartonella henselae were negative.
Blood cultures were also negative.
In the study of Mycobacterium tuberculosis, the tuberculin test was less than 5 mm, Quantiferon (QuantiFERON-TB Gold test in tube® ; Cellestis, Victoria and Australia) was negative.
The chest X-ray was normal.
An echotomography of the affected ganglion showed a right submandibular nodular formation with a diabolus morphology, 18 x 14 mm axes, non-homogeneous density and peripheral vascularization and medial region, impressing a "absence".
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Clinical suspicion of an adenitis due to NTM, and given the stage III-IV, a lymph node drainage was performed and anatomopathological study was performed. Oral treatment was initiated with a.day 5 mg/kg/kg/kg/day,
One week later, the patient returned to the hospital with a fever of 48 hours duration, with no other symptoms.
Laboratory tests showed a blood count of 1,200 leukocytes/mm3 and a neutrophil count of 300 cells/mm3, with the rest of the normal series.
PCR was normal and blood cultures were negative, the biochemical profile was normal.
Neutropenia was interpreted as a side effect secondary to rifabutin.
It was decided to start broad-spectrum intravenous antimicrobial therapy while the patient was neutropenic, rifabutin was discontinued and replaced with oral ciprofloxacin 30 mg/kg/day.
The patient became afflicted at 24 h and the neutrophil count returned to normal in subsequent controls and was discharged on the seventh day.
Culture was positive for Mycobacterium intracellulare after 25 days of inoculation.
Identification was performed using Mycobacterium Mycobacterium CM (signature in Diagnostika, Nehren, Germany) and MALDITOF (score 2.00).
Resistance, susceptibility to macrolides and resistance to quinolones and antituberculosis drugs commonly present were tested.
After eight months of antibiotic therapy, the lymphadenopathy persisted without fistula, with scarring. Finally, surgical excision was performed without complications.
