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Introduction: Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. Objectives: This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. Methods: A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. Setting: Multinational, multi-institutional, tertiary pediatric hospitals. Results: Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. Conclusion: The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation. Keywords: Atypical mycobacteria; Cervical lymphadenitis; Consensus recommendations; Non-tuberculous mycobacteria.

We report the case of a seven year old girl with 22q11 deletion mosaicism who presented with a sudden onset rapidly enlarging left parotid mass and ipsilateral facial nerve paresis. MRI and cytology were inconclusive. She underwent partial superficial parotidectomy to obtain definitive histopathology, which was reported as suggestive of acute Epstein Barr infection. A subsequent quantitative Epstein–Barr Virus (EBV) PCR clinched the diagnosis four weeks after her initial presentation. She was stared on oral Valgancyclovir and her facial nerve showed recovery. We discuss the challenges faced in managing this case with delayed conclusive diagnosis of acute Epstein Barr virus infection.