SESSION TITLE: Infectious Disease Cases II
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 27, 2013 at 01:15 PM - 02:45 PM
INTRODUCTION: Mycobacterium Scrofulaceum is a non tuberculous acid fast scotocromogen with its reservoir in the soil and water. It usually causes cervical lymphadenopathy in children and lung parenchymal infections in immunocompromised hosts, especially with Interferon gamma deficiency. Pulmonary infection with mycobacterium scrofulaceum is uncommon in immunocompetent hosts and thus no treatment guidelines exist to treat these infections(1). We present two cases of mycobacterium scrofulaceum infection in immunocompetent hosts who were successfully treated.
CASE PRESENTATION: Case 1: A 70 year-old-man with h/o COPD presented with chronic productive cough, weight loss, fatigue and mucoid expectoration. CXR and CT chest showed bilateral small pulmonary nodules, some of which were cavitating. Quantiferon gold test was negative. Patient underwent a diagnostic bronchoscopy and post bronch sputum culture grew M. Scrofulaceum which was considered a colonizer. Patient continued to be symptomatic with progression of disease on repeat CT. Treatment for Mycobacterium Scrofulaceum with three drugs- rifampin, clarithromycin and ethambutol was started with significant clinical improvement including resolution of cough and weight gain. Follow-up CT showed resolution of cavitary lesions. Repeat AFB sputum cultures were negative. Case 2: A 74 year-old-man with h/o nephrotic syndrome on low dose steroids presented with worsening cough, loss of appetite and dyspnea. CT chest showed left upper lobe nodule with cavity and diffuse tree in bud appearance, highly suggestive of TB. Patient had a bronchoscopy and BAL cultures grew M. Scrofulaceum. Considering the overall clinico-radiological picture and positive BAL M. scrofulaceum culture, triple drug therapy with rifampin, ethambutol and azithromycin was started and the patient had symptomatic as well as radiological improvement. The repeat sputum AFB cultures have been negative despite being on prednisone.
DISCUSSION: We present two cases of Mycobacterium Scrofulaceum infections in relatively immunocompetent hosts. It is rarely reported to cause symptomatic lung infection and classic cavitary nodule(s) in this subset of the population. Reports of this mycobacteria causing disease in the immunocompetent are scarce. There are no guidelines to treat lung infections in this subset of patients. We successfully treated these patients with triple therapy including rifampin, ethambutol and a macrolide.
CONCLUSIONS: M. Scrofulaceum can cause symptomatic lung infection in immunocompetent patients. Sputum/bronch cultures should be considered diagnostic in the right clinical and radiological setting. It can be successfully treated with triple therapy- rifampin, ethambutol and a macrolide.
Reference #1: Griffith DE et al. An official ATS/IDSA Statement: diagnosis, prevention and treatment of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416
DISCLOSURE: The following authors have nothing to disclose: Brendon Colaco, Manish Joshi
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