Granulomatous lymphadenitis in children.

The spectrum of granulomatous inflammation in peripheral lymph nodes in 85 children over the previous decade was systematically investigated. A variety of histopathologic features were examined and correlated with the epidemiologic, clinical, and microbiologic information, in addition to the long-term outcome. Sixty children had head or neck involvement, with atypical mycobacteria accounting for the vast majority of confirmed causes. It was most frequent in cervical and submandibular glands of children aged between 1 and 10 years (35 of 44 patients), peaking between age 2 and 5 years, and was more common in girls (male:female ratio, 1:3). Mycobacterium avium-intracellulare was the predominant pathogen, accounting for 75% of the mycobacteria that could be characterized. Granulomatous inflammation in other sites (axilla and upper extremity, 16 patients; inguinal, nine patients), or older than age 10 years rarely yielded a cause. Such patients had no recurrent or persistent clinical problems following surgical excision. Histopathologic features were extremely variable, and no consistent patterns were discerned that could reliably be related to either cause or time course. The clinical features and bacteriologic investigations were the most useful for establishing a diagnosis.