Nontuberculous Mycobacterial Lymphadenitis in Children: A French Retrospective Multicenter Study on Epidemiology, Management Strategy and Outcome Over the Last Decade

BACKGROUND: Nontuberculous mycobacterial (NTM) adenitis is increasingly recognized in children; however, optimal management strategies remain debated. The aim of this study was to describe the clinical characteristics, management and outcomes of pediatric NTM lymphadenitis in France. METHODS: We conducted a multicenter retrospective descriptive study of culture-confirmed NTM lymphadenitis cases in children across 15 French hospitals participating in the MYCOMED network between 2010 and 2019. RESULTS: A total of 279 patients were included, with a progressive increase in diagnoses over the study period, from 11 cases in 2010 to 33 in 2019, with peaks of 38 observed in 2015 and 2018. Most patients were female (64%) with a median age of 3 years. Mycobacterium avium was the most frequently isolated species (71%). Histologic examination revealed necrotizing granulomatous lymphadenitis in two-third of cases (71%, 112/115), and acid-fast bacilli staining was positive in 24.6% (68/276) of the cases. Of the 250 patients with available therapeutic data, 34.8% were treated with surgery alone, 24.8% with antibiotics alone, 28% with combined therapy and 12.4% received no treatment. Overall, 104 children were lost to follow-up. Among 175 patients with follow-up data, the overall cure rate was 96%, with no significant differences between therapeutic strategies. Relapse occurred in 6 children (3.4%). No cases of facial nerve palsy were reported; however, cosmetic sequelae related to scarring were observed. CONCLUSIONS: The incidence of pediatric NTM adenitis has increased over the last decade in France, with M. avium as the predominant species. The clinical outcome was favorable in most cases, irrespective of the management strategy. Surgery with complete excision should be considered when technically feasible and safe, while antibiotics or a "wait and see" strategy remain acceptable alternatives.