CTICasesMycobacterium immunogenum Necrotizing Lymphadenitis with Pericarditis
Imaging findings
A previously healthy 33-year-old man with malaise and shortness of breath had a chest radiograph showing an abnormal right paratracheal opacity and small right hilar calcifications. CT demonstrated extensive lymphadenopathy including a large necrotic right paratracheal/hilar lymph node exerting mass effect on the trachea, calcified right hilar nodes, a large pericardial effusion with pericardial thickening consistent with pericarditis by direct extension, and at least two splenic calcifications.
Key takeaways
Necrotic mediastinal/hilar lymphadenopathy with pericarditis and splenic calcifications in a young, immunocompetent patient should prompt consideration of granulomatous infection even when malignancy is initially suspected due to bloody pericardial fluid; pericardial window drainage and node biopsy ultimately grew Mycobacterium immunogenum, a rapidly growing non-tuberculous mycobacterium related to M. abscessus that has been linked to metalworking fluid exposure and hypersensitivity pneumonitis, an unusual cause of invasive necrotizing disease in this case.
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