A rare case of lymphadenitis and pulmonary disease caused by Mycobacterium paraffinicum

Abstract

With over 150 species, non-tuberculous mycobacteria are increasingly recognized to be important human pathogens that pose diagnostic and management challenges. We report a rare case of cervical lymphadenitis and pulmonary disease caused by Mycobacterium paraffinicum in a 64-year-old man who presented with three-month history of increasing right-sided painless neck lump. His medical history included rheumatoid arthritis, which was managed with leflunomide and methotrexate. Computed tomography scans of his neck and thorax revealed a right lower neck and supraclavicular fossa cystic mass with peripheral enhancement and bilateral multiple small pulmonary nodules. M. paraffinicum was cultured from a fine-needle aspiration of the mass. Two out of three sputa were acid-fast bacilli smear positive but cultures did not yield any viable organism. He developed spontaneous discharge of purulent material via a sinus, which drained over two months and recovered with a completely healed sinus without any further treatment.