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: Presenting a case of atypical mycobacterium in a patient with achalasia and challenges in its diagnosis and treatment.
CASE PRESENTATION: A 36-year-old man with Achalasia Cardia since his youth presented with 6 month history of non-productive cough and 3 week history of fever, chills and dysphagia prior to admission. Esophagogram revealed severe achalasia. He underwent Heller myotomy and fundoplication with resolution of his dysphagia. During this hospitalization he also had left lower lobe consolidation consistent with aspiration. He was subsequently discharged on oral antibiotics. He was readmitted two weeks later with worsening cough and an enlarging left lower lobe organizing pneumonia. Due to a suspicion of cryptogenic organizing pneumonia (COP), he was initially treated with prednisone with improvement in symptoms. A sputum culture grew acid fast bacilli subsequently identified as Mycobacterium abscessus positive for erm(41) gene. Bronchoalveolar lavage and multiple additional sputum samples were AFB culture-negative. Steroids were continued for suspected COP with symptomatic improvement but without radiologic improvement. Percutaneous lung biopsy revealed necrotizing granulomatous inflammation; smears and culture negative for AFB. Tigecycline, linezolid and amikacin were administered in preparation for planned surgical resection. Follow up chest CT two months into therapy showed persistent but decreasing size of the lower lobe consolidation.