Chest Infections: Student/Resident Case Report Poster - Chest Infections I |

Mycobacterium Asiaticum Renaissance: What to Do? FREE TO VIEW

Talat Almukhtar, MD; Abeer AlMajali, MD; Hammad Bhatti, MD; Sayed Ali, MD
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University of Central Florida College of Medicine, Orlando, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):172A. doi:10.1016/j.chest.2016.08.181
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SESSION TITLE: Student/Resident Case Report Poster - Chest Infections I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION:Mycobacterium (M) asiaticum, a rare pathogen found in sub-tropical climates, has been reported in humans with pre-existing lung disease. Although infections with M. asiaticum are rare, they often pose a clinical and therapeutic challenge, often obfuscating the overall management.

CASE PRESENTATION: A 68 year-old Caucasian gentleman presented to our clinic with a chronic cough associated with copious phlegm production. He denied fevers, weight loss, night sweats or shortness of breath. He had history of advanced metastatic prostate cancer, previously treated with multiple cycles of radiation and chemotherapy. He was maintained on antiandrogen therapy and recently started on steroids. He had normal vital signs with an oxygen saturation of 94% on room air. His physical exam revealed coarse breath sounds bilaterally. A chest x-ray showed no active pneumonia. A review of his past chest CTs’ showed interval development of a ground-glass infiltrate in the right upper lung lobe with progression to a more confluent scarring and nodular pattern over the last 6 months (Figure 1, 2). A CT-guided biopsy showed numerous histiocytes with central necrosis, consistent with a caseating granuloma. A serum quantiferon was negative. Serology for blastomycosis, coccidiodomycosis, cocryptococcus and histoplasmosis were also negative. His sputum was positive for acid fast bacillus (AFB). Subsequent cultures were reported positive for M. asiaticum, but negative for M. tuberculosis and M. avium intercellulare. The isolated bacterium was resistant to ethambutol, rifampicin and ciprofloxacin, but sensitive to linezolid, rifabutin, streptomycin, moxifloxacin, and clarithromycin. In light of his comorbidities and in the absence of systemic symptoms, our infectious disease colleagues decided not to pursue treatment.

DISCUSSION:M. asiaticum, first reported in 1982, is a rare cause of pulmonary disease in humans. Little is known about the extent, nature and treatment of this pathogen. Since guidelines on the duration of treatment and types of antibiotic to use remain unavailable, the decision to treat should be carefully weighed against the side effects. In our case, the chemotherapeutic sensitivity to M. asiaticum was similar to that in the limited number of cases reported in the literature.

CONCLUSIONS:M. asiaticum adds to the list of potential pathogens that could complicate care in immune-compromised individuals. Management of this pathogen remains vague and treatment, even though often based on expert opinion, should be considered on a case by case basis.

Reference #1: Taylor LQ, Williams AJ, Santiago S. Pulmonary disease caused by Mycobacterium asiaticum. Tubercle. 1990 Dec;71(4):303-5. PubMed PMID: 2267684.

Reference #2: Grech M, Carter R, Thomson R. Clinical significance of Mycobacterium asiaticum isolates in Queensland, Australia. J Clin Microbiol. 2010 Jan;48(1):162-7. PubMed PMID: 19864478.

DISCLOSURE: The following authors have nothing to disclose: Talat Almukhtar, Abeer AlMajali, Hammad Bhatti, Sayed Ali

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