BEYOND THE ORDINARY ATYPICAL MYCOBACTERIUM IN APPENDICULAR ABSCESS

Appendicitis is most commonly associated with blockage of the appendiceal lumen due to fecoliths, lymphoid hyperplasia, or infection. Diagnostically and therapeutically, atypical mycobacterial infections more frequently recognized as non-tuberculous mycobacteria (NTM) mycobacterial infections rarely pose difficulties by causing appendicitis. Such environments include soil and water where organisms like Mycobacterium avium complex (MAC) and Mycobacterium fortuitum are found which can infect an immunocompromised host or, on rare occasions, an otherwise healthy person.NTM appendicitis is infrequently encountered and may present like classical acute appendicitis with right lower quadrant pain, fever, and high inflammatory markers. Granulomatous inflammation with acid-fast bacilli often goes unnoticed until histopathological examination integrates these findings. For me as a medical trainee, this case underscores the need to rule out rare causes of appendicitis in patients with unusual presentation or those who are immunosuppressed. Appendectomy remains the treatment of choice in these patients however, after confirming an Non-Tuberculous Mycobacterial infection, tailored therapy is warranted to avoid recurrence or systemic dissemination of the disease.Maintaining the differential diagnosis wide open permits us to note that although uncommon atypical mycobacteria it is important to highlight that every step needs be taken for proper diagnosis and management because no other need exists alongside histology and microbiology emphasis on precision seeking diagnosis without fail.