Non-tuberculous mycobacterial empyema in an immunocompetent child

Abstract

Background: Non-tuberculous mycobacterium (NTM) species are free-living organisms that are ubiquitous in the environment. There are about 100 different species of mycobacteria of which few species cause human disease in immunocompromised individuals. The spectrum of disease caused by NTM range from pulmonary disease including cavity, consolidation , bronchiectasis, lymphadenitis, skin, soft tissue and injection site infections to disseminated disease in immunocompromised individuals. Methods & Materials: We report a 9 years old immunocompetent female patient who presented with Mycobacterium avium intracellulare (MAI) empyema. There have been only two reports to our knowledge regarding NTM in immunocompetent children causing empyema both of which were due to mycobacterium chelonae. Results: A 9 years old girl presented with left sided chest pain for 3 months. There was associated intermittent fever and cough for the last two weeks. Chest X-ray (CXR) revealed massive left sided pleural effusion. Pleural tap drained pus. She underwent thoracotomy and decortication. HIV Elisa was negative. TB MGIT culture at the end of 3 weeks grew non-tuberculous slow growing mycobacteria. Line probe assays revealed MAI. A thorough immune workup showed normal serum levels of IgG and IgM and lymphocyte subset assays. Child was started on clarithromycin, isoniazid, rifampicin and ethambutol. A repeat chest X-ray done after two months showed complete resolution of pleural fluid. Treatment is continued and child is on regular follow up. Conclusion: MAI can lead to tuberculous empyema even in immunocompetent children.