Title : Conservative management of paediatric atypical necrotising cervical lymphadenitis: A case report
Abstract:
Introduction: This case report describes the presentation, investigation, and non-surgical management of an unusual case of unilateral necrotising cervical lymphadenitis. A two-year-old girl had a three-month history of left-sided submandibular swelling which was managed by her local hospital. However, this developed into an abscess which discharged following trauma leading to skin breakdown and necrotic lymph nodes. She was then subsequently urgently referred to a specialist centre for urgent debridement as a suspected necrotising fasciitis.
Results and conclusions: On presentation, the patient was clinically well with low-grade pyrexia. There was extensive multidisciplinary input involving plastic surgery, ENT and paediatric infectious diseases teams. She was diagnosed with presumed NTM lymphadenitis with superadded Staphylococcal infection. In view of the broader clinical picture, a joint decision was made to avoid surgical intervention and she was treated with just five days of intravenous co-amoxiclav. Her wound showed significant improvement and has now healed when seen in clinic several months later.
Summary: International guidelines recommend surgical excision as the initial intervention for managing NTM without features of disseminated disease, but this is associated with significant risks. This case emphasises the importance of a multidisciplinary personalised approach when diagnosing and managing complex neck infections in children. We have demonstrated that a non-operative approach in a clinically well patient with presumed NTM lymphadenitis can lead to an excellent outcome without the risks associated with surgical management and long-term antibiotic therapy.
