Mycobacterium Abscessus Presenting as Miliary Tuberculosis: First Case Report

INTRODUCTION: Miliary tuberculosis is a severe form of tuberculosis caused by the hematogenous spread of Mycobacterium tuberculosis (MTB). Nontuberculous mycobacteria (NTM) are environmental pathogens that can become aerosolized and cause infections, particularly in immunocompromised individuals. Mycobacterium Abscessus is a rapidly growing NTM that commonly causes pulmonary disease in individuals with preexisting lung conditions. However, its presentation as miliary nodules in an immunocompetent individual is extremely rare. CASE PRESENTATION: A 57-year-old male with well-controlled diabetes presented with progressive dyspnea, chronic dry cough, low-grade fever, and significant weight loss over three months. Chest radiography revealed diffuse miliary opacities, initially suspected to be tuberculosis. Despite receiving standard anti-tubercular therapy, his symptoms persisted. Further investigations, including bronchoalveolar lavage culture and NTM line probe assay, confirmed infection with Mycobacterium abscessus. The patient was treated with a combination of clarithromycin, linezolid, amikacin, and imipenem for the initial three months, followed by clarithromycin and linezolid for a total treatment duration of 15 months, resulting in a favorable outcome. Follow-up high-resolution CT scans showed complete resolution of the miliary lesions, and the patient continues under clinical surveillance for recurrence. CONCLUSION: This case highlights that Mycobacterium Abscessus infection can mimic miliary tuberculosis, even in immunocompetent individuals. Nontuberculous mycobacterial infections should be considered in patients with miliary lung opacities who do not respond to standard anti-tubercular therapy. Early diagnosis and prompt initiation of appropriate antibiotic treatment can result in successful outcomes.