Non-Tuberculous Mycobacteria Infection in a Nigerian Teenager in Uyo; A Case Report

Non-Tuberculous Mycobacteria are species other than the Mycobacterium tuberculosis complex which cause a wide range of diseases (excluding leprosy) in children and adults especially those with interruptions to their cell mediated immunity as seen in patients with the Human Immunodeficiency Virus (HIV). The most common manifestation of this infection is cervical lymphadenitis which may rupture to form ulcers. Our patient is a 17-year-old teenager who presented initially to a primary health care centre (PHC) with complaints of neck swellings/ulcers, weight loss, and recurrent fever of 18 months duration. She tested positive for HIV and TB (gene expert) at the PHC and was commenced on standard HIV and TB medications at the PHC. Due to persistence of symptoms, she was referred to our facility, where repeat TB medications and antibiotics were administered with non-resolution of neck swellings/ulcers. Line probe assay done was suggestive of non-Tuberculous Mycobacterium. Culture was not done as sample was lost in transit to the reference lab. Patient received a six-month course of Oral Azithromycin and TB medication with surgical excision of affected lymph nodes and showed marked resolution of symptoms. High Index of suspicion is needed when evaluating patients for TB, especially when they have significant cervical lymphadenopathy/ulcers and do not respond adequately to standard therapy. There is also a need for increased availability of culture facilities in resource-challenged countries like ours.