Nontuberculous mycobacterial (NTM) cervical adenitis in children is a largely self-limited infection afflicting healthy immunocompetent children, frequently in those before the age of 5 years. The diagnosis and management of NTM cervical adenitis in children remains challenging and is highly variable.

Firstly, accurate and timely identification of NTM species is crucial for appropriate management, but currently a gold-standard diagnostic test remains elusive and thus, distinguishing NTM from other causes of subacute cervical adenopathy, both infectious and non-infectious, can be difficult, especially in the early stages of infection.

Treatment strategies are also variable, ranging from expectant management to long-term antimicrobial therapy and surgical excision. With respect to antimicrobial therapy, there has historically been little consensus on the most effective antimicrobial regimen and duration. The spectrum of treatment varies from a conservative approach, treatment with long-term antimicrobial therapy, to surgical intervention, ranging from incision and curettage to complete excision of the involved lymph nodes. The balance between minimizing treatment-related complications and sequelae and ensuring complete eradication of infection remains a challenge.

In summary, the controversies in NTM cervical adenitis management revolve around diagnostic uncertainties and diverse treatment approaches. The objective of this lecture is to provide an approach to the diagnosis of the pediatric patient with subacute cervical lymphadenopathy and then present the advantages and disadvantages of surgical versus conservative management approaches, using best-available evidence and clinical vignettes.