Depression During Prolonged Diagnostic Uncertainty in Non-Tuberculous Mycobacterial Infection

Abstract

Non tuberculous mycobacterial infection may resemble pulmonary tuberculosis, particularly in tuberculosis endemic settings, and confirmation often requires repeated microbiological evaluation before the causative organism is identified. During this period patients may experience persistent symptoms, treatment interruptions, and
considerable uncertainty regarding the course of illness. A 38-year-old woman underwent a complex four-year diagnostic course before infection with Mycobacterium other than tuberculosis was confirmed. She was initially treated for pulmonary tuberculosis but developed drug reactions and repeatedly inconclusive microbiological results. As investigations continued without diagnostic clarity she developed emotional exhaustion, sleep disturbance, functional decline, and persistent low mood. Psychiatric evaluation revealed a Patient Health Questionnaire 9/17 and a Generalized Anxiety Disorder 7/7, consistent with severe major depressive disorder. Management included supportive psychotherapy, family psychoeducation, and initiation of sertraline alongside ongoing multidisciplinary care involving psychiatry, pulmonology, and dermatology. After psychiatric involvement the patient reported better understanding of the diagnostic process and remained engaged with treatment while further microbiological identification was pursued. The clinical course reflects the psychological strain that prolonged diagnostic uncertainty may impose during the evaluation of chronic infectious disease.