SHM Converge Scientific Abstract ePoster Gallery-Nontuberculous Mycobacterial Pulmonary Infections: A Therapeutic Challenge

Pdf Summary

A 54-year-old man with opioid use disorder, housing insecurity, and hypoplastic myelodysplastic syndrome presented with one month of dyspnea, productive cough, fever, chills, and a 20-pound weight loss. He had recently been treated for presumed pneumonia with levofloxacin and prednisone without improvement. On exam he was tachycardic and hypoxic, with increased work of breathing and diffuse coarse breath sounds. Chest X-ray showed no consolidation, but CT chest revealed a right perihilar soft tissue mass compressing the bronchus intermedius and encasing the right pulmonary artery, initially raising concern for bronchogenic carcinoma.<br /><br />Further workup clarified the diagnosis: bronchoalveolar lavage cultures grew Mycobacterium abscessus, fine needle aspiration of the mass and surrounding lymph nodes was negative for malignancy, and 2/2 admission blood cultures also grew M. abscessus on hospital day seven. He was started on a multidrug regimen of amikacin, imipenem, eravacycline, and tedizolid, with a planned prolonged 6- to 12-month IV antibiotic course.<br /><br />This case highlights M. abscessus as an opportunistic pathogen in vulnerable hosts, including patients with chronic lung disease or immunocompromise. Although uncommon, it can cause pulmonary disease, skin and soft tissue infection, CNS infection, and bacteremia. Diagnosis relies on clinical suspicion plus microbiologic confirmation, since imaging may mimic malignancy or other infections.<br /><br />Treatment is challenging because M. abscessus is highly resistant to standard antituberculosis and many antimicrobial agents. Cure rates are limited, and management usually requires macrolide-based multidrug therapy for a prolonged duration, often at least 12 months after negative respiratory cultures in pulmonary disease. Early recognition is important to prevent progression and improve outcomes.

Asset Subtitle

Elizabeth Freese

Meta Tag

Author List Elizabeth Freese, Haley Briggs, PA-C

Category Clinical Vignettes

Concept Mycobacterium abscessus

Concept Multidrug Resistance

Concept Opportunistic Pathogen

Concept Pulmonary infection

Concept Disseminated infection

Distinguished Non-Finalist

Presenter Organization University of Colorado Division of Hospital Medicine

Presenting Author Elizabeth Freese

Track Adult

Keywords

Mycobacterium abscessus

pulmonary infection

bronchoalveolar lavage

bacteremia

bronchogenic carcinoma mimic

multidrug antibiotic therapy

amikacin

imipenem

immunocompromised host

myelodysplastic syndrome

Mycobacterium abscessus

Multidrug Resistance

Opportunistic Pathogen

Pulmonary infection

Disseminated infection