Miliary pulmonary infection caused by Mycobacterium terrae in an autologous bone marrow transplant patient

A 64-year-old woman with ovarian carcinoma that had been treated with high-dose chemotherapy and autologous bone marrow transplantation presented with a maculopapular rash on the extremities and miliary infiltrates evident on chest roentgenogram. Transbronchial biopsy specimens revealed caseating granulomas, and cultures grew Mycobacterium terrae. Six weeks after therapy with isoniazid, rifampin, and pyrazinamide was begun, her rash and pulmonary infiltrates had cleared, despite the in vitro resistance to these drugs and continued spread of her carcinoma. This case suggests that spontaneous resolution may be part of the natural history of M terrae infections.