Biography
Biography: Sadiya Zinjani
Abstract
The first impression on seeing this 5.6 year girl with a Lt. parotid swelling was? Mumps, but it was only when antibiotics provided relief the possibility of a pyogenic infection was considered. In 2018 she made 2-3 visits with parotid swellings, but by October 2018 she had developed bilateral parotitis not responding to routine antibiotics. USG followed by CEMRI in November 2018 revealed bulky parotid glands with multiple thick walled loculated abscesses and regional lymphadenopathy. Both FNA and abscess debridement tissue microscopy revealed numerous epithelioid cell granulomas with multinucleated giant cells and some Langhans cells in a necrotic base. ZN stain for AFB was positive. Mycobacterium culture by MGIT and Genexpert MTB was negative. When the patient failed to respond to ATT, Clarithromycin was added and by 2 weeks the incision scar was all that was visible. Parotitis caused by NTM is an uncommon problem, commonly involving young children. Infections caused by NTM are now more frequently encountered perhaps due to a greater awareness and advanced diagnostics NTM are being recognized as causative agents in various symptomatic disease states. They are now being implicated in various disease manifestations in immunocompetent hosts. In most cases of parotitis, M. avium is the causative pathogen; other mycobacteria have also been reported as causative agents in some cases. In our case the histopathological picture augmented by the culture reports and failure to respond to ATT confirmed our diagnosis of NTM parotitis.