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Diagnostic and therapeutic dilemma of cervical adenitis in an adult
  1. Devika Singh1,
  2. Shirley Sit2 and
  3. Narendra Singh2,3
  1. 1Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Pediatrics, Humber River Hospital, Toronto, Ontario, Canada
  3. 3Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Devika Singh; singhd25{at}


Citrobacter freundii infections have not been previously described as an aetiology for lymphadenitis in healthy adults. Non-tuberculous mycobacteria (NTM) infections typically occur in young children or immunocompromised individuals, with few cases seen in adults. A woman in her 20s presented with lymphadenitis that was subsequently positive for C. freundii and NTM on needle biopsy and was treated with antibiotics. The patient was followed up for 3 months with regular ultrasound scans and is currently asymptomatic. The excisional biopsy was cancelled as a result. This case highlights the complexity of making a diagnosis in some patients with cervical adenopathy, and as such, it is crucial to use the patient’s clinical course to guide treatment modalities. Contamination was a possibility in this case given the number of organisms shown on biopsy and the lack of response to treatment, and we provide an approach to management in this case of uncertainty.

  • ear, nose and throat/otolaryngology
  • infectious diseases
  • ultrasonography

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  • Contributors DS, SS and NS contributed to the design of the report, the analysis of the results and the writing of the manuscript. DS was responsible for acquiring the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.