Mycobacterium avium complex (MAC) presenting as the first infection in a child with cystic fibrosis

Nontuberculous mycobacteria (NTM) have been increasingly recognized in recent years as contributors to clinically significant lung infection in cystic fibrosis (CF) patients. Reports of prevalence vary from 6 to 22% around the world. Prevalence estimates in childhood CF is challenging since sputum producers are rare, bronchoalveolar lavage is an invasive procedure and may not be feasible, and mounting evidence deeming throat cultures to be unsuccessful in detecting NTM. We report a case of an overall healthy 13 year old young adolescent female with CF, who presented with Mycobacterium avium complex (MAC) as her first documented lung infection, and while only presenting with minor cough proved to have severe purulent bronchial infection. Contrary to common paradigms, NTM can be the first infection in a non-previously infected airway, and, this first infection can be of a serious nature unlike the more subtle anticipated pattern. The causes of the high and probably increasing overall incidence of NTM and specifically in CF elude explanation and mandate further study. Continuing efforts should be invested into the study of all aspects of this ominous infection.