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Fatal Pulmonary Mycobacterium celatum Infection in an Immunocompetent Patient. An Eight-Year Follow-up of the First Swedish Case, A Review of the Literature, and a Report of Beta-2 Microglobulin as a Potential Indicator of Disease Severity FREE TO VIEW

Stefan Rustscheff, MD; Johan Darelid, MD
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Värnamo General Hospital, Värnamo, Sweden

Chest. 2011;140(4_MeetingAbstracts):774A. doi:10.1378/chest.1112086
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PURPOSE: Pulmonary M. celatum infection has previously been described only twice in an immunocompetent individual with no pre-existing chest disease. We describe the first Swedish case, which also happens to be fatal , report of unusual drug-related complications, report of the possible utility of beta-2-microglobulin as a way of measuring disease activity in mycobacterial diseases and review the literature.

METHODS: Clinical study.

RESULTS: Atypical mycobacterioses are often difficult to treat. We have followed a case of m celatum pneumonia in a previously healthy patient for eight years, who unfortunately became both blind and deaf during treatment until the fatal termination of her severe illness. We deem those conditions to be clearly treatment-related. As in a previously reported paper on m. tuberculosis, her beta-2-microglobulin levels seemed to correlate rather well to the extent of her disease which we believe may become an instrument of potential value in the treatment of granulomatous disorders.

CONCLUSIONS: M celatum may cause fatal pneumonia in previously healthy individuals.Treating the disease may be fraught with difficulty and there is a risk of very severe side effects, all of which must be weighed before taking the decision to treat this disease.

CLINICAL IMPLICATIONS: Mycobacterium celatum is a true pathogen, capable of killing a previously healthy, immunocompetent individual. Treatment with ethambutol and amikacin may cause bilateral retinal thrombosis and deafness. Other ototoxic drugs added to a regime containing amikacin may precipitate this condition. Beta-2-microglobulin may be a useful test in order to follow disease progression in not only tuberculosis but other granulomatous disorders as well.

DISCLOSURE: The following authors have nothing to disclose: Stefan Rustscheff, Johan Darelid

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