Mycobacterial disease causing chylous effusions in two patients living with uncontrolled HIV

Chylous effusions are a rare complication of disseminated non-tuberculous mycobacterial (NTM) infection. This is a case couplet reporting on the treatment challenge of chylous effusions secondary to NTM infection in two individuals living with advanced HIV. Their treatment was complicated by associated immune reconstitution inflammatory syndrome. They both required intermittent paracentesis, steroid treatment and transitioning on to fat-free diets alongside NTM treatment. Only after months of this treatment regimen was successful resolution of the associated chylous effusions achieved. Chylous effusions in immunosuppressed patients living with NTM infection are rarely reported and difficult to manage. This report discusses treatment approaches and highlights the difficulties faced by the treating team.