Mediastinal nontuberculous mycobacteria as a cause of pediatric airway obstruction

Nontuberculous mycobacterial infections are seen frequently in the head and neck region in immunocompetent young children in their toddler years. These infections usually present as an inflammatory neck mass that is refractory to standard antibiotic therapy. We describe a previously healthy 16-month-old boy presenting with persistent wheezing despite treatment for reactive airway disease. At bronchoscopy a large carinal mass compressing both main stem bronchi was found. Subsequent thoracoscopic biopsy and culture revealed Mycobacterium avium complex. The rationale for serial bronchoscopies as well as diagnostic, medical and surgical management options are discussed.