A 57-Year-Old Man with Mycobacterium Mageritense and Pneumocystis Jirovecii Coinfection after Loss to Follow-Up for 9 Years

Abstract

Future randomized controlled trials are required to develop better treatment strategies. Herein, we present a case of pneumonia caused by M. mageritense. A 57-year-old man with a history of being a human immunodeficiency virus (HIV) carrier and who had been irregularly followed up in outpatient clinics for approximately 9 years was previously treated with Kaletra and Kivexa. He had a cough with sputum and shortness of breath for week. The patient presented to the emergency roomwith respiratory distress. Subsequent high-resolution computed tomography of the thorax revealed thickening of the interstitial lines,a honeycomb pattern in both lungs, and patchy consolidation in the right lower lobe. A sputum test yielded positive results for Pneumocystis jirovecii. Trimethoprim/sulfamethoxazole was prescribed for the P. jirovecii infection. Mycobacterium culture identified M. mageritense using a matrix-assisted laser desorption ionization time-of-flight method. Ciprofloxacin, linezolid, and imipenem/cilastatin were prescribed for 16 d, followed by a shift to linezolid and ciprofloxacin after discharge. After 8 months of treatment, the patient improved well. M. mageritense can induce infections in both immunocompetent and immunocompromised individuals. It has a broad spectrum of clinical manifestations. Treatments include surgical intervention and combined antibiotics [1]. P. jirovecii-induced pneumonia (PJP) and nontuberculous mycobacterial diseases share overlapping risk factors. Our case demonstrated coinfection with M. mageritense and P. jirovecii. Careful differentiation of opportunistic infections in patients with HIV is warranted. However, the optimal antibiotic therapy duration for M. mageritense remains uncertain. Future randomized controlled trials are imperative for the development of enhanced treatment strategies.