Non-Tuberculous Mycobacterial Parotitis in Children

To the Editor:  Four children (3 boys, 1 girl) aged 3–6 y, presented between June 2023 and January 2024 with unilateral suppurative parotitis of 1–9 mo duration. They had recurrent swelling, pain, redness, and intermittent discharge in the parotid region. None had fever, weight loss, tuberculosis exposure, or environmental risks. They had received empirical antibiotics, surgical drainage and anti-tubercular therapy (ATT) with no effect. Pus aspiration and metagenomic sequencing (mNGS) confirmed Mycobacteroides abscessus in three cases, while culture was positive in one. Drug susceptibility testing showed the organism was susceptible to amikacin, clarithromycin and tigecycline, intermediate to linezolid, and resistant to ciprofloxacin, cotrimoxazole, doxycycline and imipenem. All had granulomatous inflammation and Xpert MTB was negative. They received combination therapy with injectables like tigecycline, amikacin for 2 wk − 2 mo and oral drugs including macrolides, levofloxacin, linezolid and clofazimine for minimum 3 mo. HIV testing and primary immune-deficiency testing including nitroblue tetrazolium (NBT) test was negative in the culture proven case. One child had a relapse two weeks after stopping therapy and one case was lost to follow up at 2 mo. …