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Clinical Note |

Sequelae of Rapid Growing Mycobacteria Otomastoiditis in a Child

Michael J. McAvoy, DO; Michael A. Carron, MD; Janet Poulik, MD; Dennis Altinok, MD; Walter Belenky, MD
Arch Otolaryngol Head Neck Surg. 2009;135(6):602-604. doi:10.1001/archoto.2009.52.
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and Mycobacterium peregrinum are nontuberculous mycobacteria (NTM). They belong to a subset of NTM known as rapid-growing mycobacteria (RGM), previously designated as Runyon class IV. Rapid-growing mycobacteria are saprophytic, ubiquitous in nature, and generally considered nonpathogenic. Several species of RGM, including M fortuitum and M peregrinum, are potentially pathogenic in humans. Mycobacterium fortuitum infections are typically cutaneous, occurring when the skin barrier has been breached. No pattern of infection by M peregrinum has been established. Herein, we discuss a pediatric case of otomastoiditis that progressed to petrous apicitis, intracranial empyema, and meningitis despite appropriate medical and surgical therapy. Initial laboratory identification in this case listed M fortuitum with a follow-up laboratory identification by the Centers for Disease Control and Prevention (CDC) listing the M fortuitum/M peregrinum group. Because the CDC did not classify to the species level we cannot be certain that this case was not caused by M peregrinum, which phylogenetically is very closely related to M fortuitum. It is a member of the M fortuitum group and was considered a biovariant of M fortuitum until 1992. There are no previous reports of M peregrinum causing an otologic infection in the literature. To our knowledge, only 2 cases of mastoiditis and 1 case of a subdural empyema in the pediatric population caused by M fortuitum are documented in the literature. Considering the aggressive nature and serious otologic and intracranial consequences of these rapid growing mycobacteria, it is important to document this in the literature.

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Figure 1.

T2 weighted axial fast-spin echo fat-saturated image demonstrates diffuse increased signal of petrous and mastoid bone with associated partial erosion consistent with osteomyelitis.

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Figure 2.

Multiple granulomas with central necrosis, surrounded by epithelioid histiocytes, giant cells, and a collarette of lymphocytes (hematoxylin-eosin, original magnification × 4).

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Figure 3.

Gadolinium-enhanced T1 weighted axial fat-saturated image. The image demonstrates a small encapsulated collection within the cerebellopontine angle cistern on the right suggestive of epidural infected collection.

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Figure 4.

Gadolinium-enhanced T1 weighted coronal fat-saturated image. The image demonstrates extensive enhancement along the dural surface of the basal cistern on the right with associated small encapsulated collection consistent with basal meningitis and small subdural infected collection.

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