Abstract
The management of macrolide-resistant Mycobacterium avium complex (MAC) disease is challenging. It is extremely rare for non-human immunodeficiency virus (HIV)-infected patients to develop disseminated MAC disease. A 73-year-old non-HIV-infected woman was diagnosed with MAC lung disease (MAC-LD) for 20 years and subsequently chronic necrotizing pulmonary aspergillosis for three years. To avoid drug interaction between rifampicin and voriconazole, MAC-LD was treated with clarithromycin (CLR) alone. The results of the bone biopsy and bone marrow culture conducted for back pain were compatible with CLR-resistant MAC vertebral osteomyelitis. The clinical management of CLR-resistant disseminated MAC disease consisting of lung and spinal lesions with no established treatment and a poor prognosis is challenging. In this case, the patient was treated with multidrug antibiotic therapy, including CLR, ethambutol, rifampicin, amikacin, and moxifloxacin. The results show the effectiveness of multidrug antibiotic therapy in treating CLR-resistant disseminated MAC disease.
Highlights
The incidence of pulmonary non-tuberculous mycobacterial (NTM) disease has increased 2.6 times from 2007 to 2014 [1,2]
We report the case of a non-human immunodeficiency virus (HIV)-infected patient with CLR-resistant disseminated Mycobacterium avium complex (MAC) disease consisting of lung and spinal lesions that developed during treatment for Mycobacterium avium complex lung disease (MAC-LD) with CLR alone and was complicated by VRCZ-treated chronic necrotizing pulmonary aspergillosis (CNPA)
This report indicates that the multidrug antibiotic therapy comprising CLR, RFP, EB, AMK, and MFLX, which has not yet been established, led to the remission of CLR-resistant disseminated MAC disease that consisted of lung and spinal lesions
Summary
The incidence of pulmonary non-tuberculous mycobacterial (NTM) disease has increased 2.6 times from 2007 to 2014 [1,2]. We report the case of a non-HIV-infected patient with CLR-resistant disseminated MAC disease consisting of lung and spinal lesions that developed during treatment for MAC-LD with CLR alone and was complicated by VRCZ-treated CNPA. This case report was previously presented at the Japan Primary Care Association’s Kanto Ko-Shin-Etsu Block Regional Meeting on November 19, 2017. The results of gastroscopy, colonoscopy, and thoracic and abdominal pelvic contrast-enhanced CT scans were unremarkable for a definitive diagnosis She was transferred to our hospital for further examination and treatment. Infectious test β-D glucan Aspergillus antigen M. tuberculosis IFN-γ HIV antibody M. avium PCR M. tuberculosis PCR
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