Clinical Note
June 2009

Sequelae of Rapid Growing Mycobacteria Otomastoiditis in a Child

Author Affiliations

Author Affiliations: Departments of Pediatric Otolaryngology (Drs McAvoy, Carron, and Belenky), Anatomic Pathology (Dr Poulik), and Radiology (Dr Altinok), Children's Hospital of Michigan, Detroit.


Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Otolaryngol Head Neck Surg. 2009;135(6):602-604. doi:10.1001/archoto.2009.52

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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