Misdiagnosis of Mycobacterium abscessus Pulmonary Infection as Pulmonary Tuberculosis

Abstract

Introduction: Mycobacterium absessus is one of the important pathogens of rapidly growing mycobacteria, which can cause various infections in humans. Non-tuberculosis pulmonary infection is similar to pulmonary tuberculosis and can be misdiagnosed as Mycobacterium tuberculosis. In this study, a case of pulmonary infection of M. abscessus is reported in healthy patients with previous pulmonary tuberculosis from Iran. Case Presentation: The patient was a 85 year-old woman admitted to a hospital due to productive cough, dyspnea, fever, night sweats, weigh lost, hemoptysis, chest pain, anorexia, vomiting, and hematuria who had the history of pulmonary tuberculosis. According to clinical manifestation, laboratory examination, chest X-ray, and presence of acid-fast bacilli in direct smear, reactivation of tuberculosis was assumed and anti-TB chemotherapy was started; however, the patients’ symptoms were not improved. The causative agent was isolated from the sputum samples of the patient and identified as Mycobacterium abscessus by using phenotypic tests and molecular method. According to the antibiotic susceptibility results, the patient was treated with linezolid, amikacin, and cefoxitin after two weeks. Conclusions: This is the first report of pulmonary infection caused by M. abscessus in patients with a history of pulmonary tuberculosis in Iran. Therefore, for the purpose of patient management, final diagnosis and appropriate treatment, non-tuberculosis mycobacteria (NTM) should be identified to the species level.