WFPI TB Corner November 2016 Introduction Mycobacterium tuberculosis (TB) accounts for around 95 percent of mycobacterial infections. Nontuberculous mycobacterium (NTM) also known as atypical mycobacterium or mycobacterium other than tuberculosis (MOTT) accounts for the remaining 5 percent of disease (2). NTM is a distinct group of organisms with more than 150 catalogued species (3). The notable increase in number of cases of NTM for the past 30 to 40 years has been attributed to improved detection rates and the increase in opportunistic infections brought about by the HIV-AIDS pandemic. Pulmonary infections, lymphadenitis, skin and soft tissue infections are among the major diseases associated with NTM infection (3). In the pediatric population the annual incidence rate of NTM was estimated to be 0.77 cases per 100,000 children. Lymphadenitis is the most common manifestation in children, followed by pulmonary disease (4). This case report will discuss an unusual case of nontuberculous mycobacterial pneumonia in an infant. The clinical presentation and the key imaging features will be highlighted to help distinguish NTM from TB pneumonia. Case Presentation A 13-week old female infant was admitted to a tertiary medical center in the Philippines for rapid breathing and notable weight loss. Patient was born full term with a birth weight of 2.95 kg without perinatal complications. Pure breastfeeding was supplemented with virgin coconut oil (1 ml given 5-7x a day) and dibencozide due to poor weight gain. At age 13 weeks, the patient was noted to have fast breathing with no fever, cough or colds. On pediatric consult, the body weight was 3.65 kg, and the infant had good suck and clear breath sounds. Initial chest x-ray showed consolidation at the right upper and both lower lobes. Lateral view demonstrated lobulated soft tissue densities reflective of hilar lymphadenopathy [see Fig. 1]. Gautam R, et al. TB Corner 2016; 2(6):1-7 1 Abstract Nontuberculous mycobacterium (NTM) is a distinct group of organisms presenting with lymphadenitis and pulmonary infection as the common manifestations among pediatric population. The diagnosis of pulmonary NTM disease is based on clinical manifestations, radiologic findings and microbiologic culture. This is a report of a confirmed case of NTM pneumonia in a 13-week old infant who presented with poor weight gain and tachypnea. Chest radiographs at the time of admission showed consolidation of the right upper and both lower lobes and hilar lymphadenopathy. The chest CT scan showed necrotizing pneumonia as well as enlarged and matted lymph nodes reflective of primary progressive tuberculosis with advanced lymph node and lung disease. The diagnosis of Mycobacterium abscessus pneumonia was confirmed after 6 weeks of confinement through a positive gastric aspirate culture and speciation for M. abscessus. Household screening tests revealed that a grandparent whose sputum tested positive for M. abscessus. The patient received amikacin, cefoxitin, and clarithromycin based on the results of the culture and sensitivity. The patient received the antibiotic treatment for one year, and underwent quarterly gastric aspirate AFB smear and culture. The patient responded to the treatment and had no recurrence after 1 year. This case report highlights the difficulty of establishing the diagnosis of NTM infection that requires a high index of suspicion and multiple tests and procedures to isolate the causative agent. Radiographic features are very similar to those seen in complicated tuberculosis infection. The clinical manifestations and imaging features that characterize NTM and mycobacterium tuberculosis will aid in timely diagnosis and treatment of the disease. Nontuberculous Mycobacterial Pneumonia: Radiologic and Clinical Correlation in an Infant Presenting with Respiratory Distress Rupesh Gautam 1 , Maria Isabel Atienza 2,4 , Bishnu Sigdel 3 , Maika Noda 2 , and Mariaem Andres 2,4 Chitwan Medical College, Bharatpur, Nepal 1 , St. Luke’s Medical Center Quezon City 2 , Kaohsiung Chang Gung Memorial Hospital, Taiwan 3 , and St. Luke’s Medical Center, Global City 4