Mystery Diagnosis Part III

By the following day when I went into Student Health to have my PPD test read, the swelling had gotten even worse, and I didn't need the nurse's reading to know that I had had a positive reaction. I was immediately sent to Radiology for a chest x-ray to determine whether or not I had active TB. It was the day before Thanksgiving.

My chest x-ray turned out to be negative, which was consistent with the fact that I had no cough or any other symptoms associated with Tuberculosis. Despite the fact that I had had such a strong reaction to the TB skin test, I knew that it did not necessarily mean that I had Mycobacterium tuberculosis. There are a number of other "atypical" mycobacteria that may also cause a positive PPD test. Unfortunately I was told by Pathology that it would take at least 5 weeks to determine exactly what kind of mycobacteria I was infected with. From my time in the TB lab, I knew that M. tuberculosis grows very slowly in culture, so I figured they probably needed that long to grow enough of the bacteria in order to identify it. In the meantime, I was referred to both the department of Infectious Disease and the department of Rheumatology (for the possible autoimmune component).

Since it was the holidays and pushing through referral papers always presents as a bureaucratic bottleneck, there was nothing to be done for the time being. I tried to forget about it for the holiday weekend and focus on the massive amounts of food that needed to be cooked and eaten.

A couple of weeks later, I got an appointment with Infectious Disease (actually much more quickly than normal since my case was marked 'urgent'). After once again relaying my history, I was told by the Infectious Disease doctor that although the species of mycobacteria I was infected with was still not known, they could already tell by the speed at which it was growing that it was not M. tuberculosis, but rather a an atypical "rapid-grower" mycobacteria. The specimen was sent to National Jewish Labs in Colorado, the only lab in the country that specializes in testing these bacteria for antibiotic sensitivity. Without knowing which antibiotics it was susceptible to, there would be no course of treatment for my still-swollen parotid gland.

A few days after the appointment, I got a call from my Infectious Disease doctor. The species of my mycobacteria had been identified as Mycobacterium abcessus. I was told that as rare as mycobacterial infections of the parotid gland are, infection by this type of mycobacteria is EVEN MORE rare. In fact, it is so rare that hardly any cases have ever been reported. Not even the experts at National Jewish Labs, who receive referrals for parotid gland infections from everywhere in the country, have ever personally seen a case like mine. Therefore no one could give me a predicted outcome, and no one could provide any logical explanation of why this had happened to me.

My doctor did inform me of some potential risks of this type of infection, which included the formation of an abscess that would require surgery, and the spread of the infection to the blood vessels surrounding the parotid gland. The sensitivity testing on the specimen would still take several weeks to complete, but I was advised to call Infectious Disease if I ever came down with a fever or severe headache.

Over the next few weeks, the swelling in my salivary gland seemed to improve. The size of the lump had reduced and it was not nearly as painful as it once was. For a while, I was able to put it at the back of my mind. The Christmas holidays came, and our parents came into town to celebrate with us. The day after my parents arrived, we planned to do all of our holiday grocery shopping. However, I was feeling extra lethargic and could not seem to get warm. So I backed out of the shopping trip and took a nap instead. When I woke up, I realized I definitely had a fever.

TO BE CONTINUED ...