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Case Reports in Medicine
Volume 2014, Article ID 964612, 5 pages
http://dx.doi.org/10.1155/2014/964612
Case Report

Nontuberculous Mycobacteria Immune Reconstitution Syndrome

1Infectious Diseases Unit, Department of Internal Medicine, Greys Hospital and University of KwaZulu Natal, Pietermaritzburg, KwaZulu-Natal 3201, South Africa
2Midlands Business Unit, Department of Pathology, National Health Laboratory Service, Pietermaritzburg 3201, South Africa
3Gastroenterology Unit, Department of Internal Medicine, Greys Hospital and University of KwaZulu Natal, Pietermaritzburg, KwaZulu-Natal 3201, South Africa

Received 17 July 2014; Accepted 21 October 2014; Published 11 November 2014

Academic Editor: Jacques F. Meis

Copyright © 2014 J. C. Mogambery et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The prevalence of nontuberculous mycobacteria infection (NTM) in Sub-Saharan Africa is estimated to be less than 1%. NTM is often underdiagnosed or misdiagnosed as tuberculosis in patients who present with immune reconstitution syndrome (IRS) following initiation of antiretroviral treatment (ART). Immune reconstitution syndrome is common in patients who start ART with low CD4 counts and high HIV viral load. Furthermore, Mycobacterium avium complex (MAC) commonly infects those with CD4 counts less than 50 cells/mm3. Three patients, with low baseline CD4 counts, presenting with NTM following the initiation of antiretroviral treatment are described in this case series. The first patient presented with disseminated NTM two weeks after commencing antiretroviral treatment. Acid fast bacilli were found in the liver, duodenum, and bone marrow and were suggestive of MAC microscopically. The second developed cervical lymphadenitis following the initiation of ART. Lymph node aspirate culture grew NTM. The last patient developed pancytopenia after 3 months of ART. AFB was seen on bone marrow biopsy. Culture of the bone marrow aspirate was suggestive of NTM. All three patients improved on ethambutol, clarithromycin, and rifampicin. NTM may be underdiagnosed in areas with a high TB prevalence and should be actively excluded by culture.