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Roberto Alfonso Accinelli1,2,3, Alfredo Camposano1,2

  • 1Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú.

Revista Peruana De Medicina Experimental Y Salud Publica
|September 3, 2020
PubMed
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This case study details a challenging Mycobacterium intracellulare infection in an immunocompetent patient. Successful treatment involved a multi-drug regimen including azithromycin and ethambutol after initial therapy failure.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Medical Case Reports

Background:

  • A 49-year-old immunocompetent female presented with respiratory symptoms including cough and hemoptysis.
  • Initial diagnosis was bronchiectasis, leading to a middle lobe segmentectomy.
  • Tuberculosis was unexpectedly identified post-operatively, initiating anti-TB treatment.

Observation:

  • The patient initially received a standard regimen (4HREZ2R2H2) for tuberculosis, which proved ineffective.
  • Subsequent treatment with a new scheme (4HREZ2R2H2) also failed to achieve negative results.
  • Genotyping identified Mycobacterium intracellulare, prompting a shift to a tailored antibiotic regimen.

Findings:

  • The patient was treated with azithromycin, moxifloxacin, and ethambutol, showing initial improvement.

Related Experiment Videos

  • Treatment adherence was an issue, with abandonment and later re-initiation.
  • A dermal reaction to moxifloxacin necessitated its replacement with amikacin.

    • Implications:

    • This case highlights the complexity of treating non-tuberculous mycobacterial infections, specifically Mycobacterium intracellulare.
    • Genotyping is crucial for guiding effective antimicrobial therapy in refractory cases.
    • Successful management requires a multi-faceted approach, including patient adherence and management of co-morbidities.