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• W2765851113 abstract "SESSION TITLE: Lung Infections 2 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Mycobacterium Fortuitum is a rapid growing non-tuberculous mycobacterium that rarely causes disease in immunocompetent patients. However, when pathogenic it manifests as soft tissue or catheter associated infections and rarely has isolated pulmonary manifestations. CASE PRESENTATION: A 46 year old non-smoking male with a history of hypertension and presumed COPD presents with worsening dyspnea for one week. Vague respiratory symptoms have been present for years, requiring multiple rounds of antibiotics and steroids with improvement after each course. Current therapy is Advair and Albuterol as needed. Exposure history is pertinent for three military tours in the Middle East and he currently owns a horse farm. Physical exam was positive for diffuse expiratory wheezing in all lung fields and mild tenderness over his maxillary sinuses. CT Chest revealed multiple bilateral noncalcified lung nodules, nodular pleural thickening along the lateral right hemithorax, and mediastinal lymphadenopathy. Extensive autoimmune and infectious workups were negative, including evaluation for TB. EBUS with transbronchial biopsy of four lymph nodes was nondiagnostic. BAL fluid was macrophage predominant with negative cultures and cytology. IR evaluated patient for percutaneous biopsy of a nodule but was unable to find a safe window to perform the procedure. AFB sputum and BAL cultures eventually grew M. Fortuitum in all specimens. Treatment was started with Amikacin and Levaquin dual therapy with improvement in symptoms. After one to two months of induction, he will be transitioned from Amikacin to Doxycycline with Levaquin to complete a minimum of six months of therapy. DISCUSSION: M. Fortuitum is a rare cause of pulmonary disease. Commonly it is seen as a colonizer, but rarely is pathogenic. Diagnosis is made with positive cultures on two samples and pulmonary symptoms or radiographic changes. Our case identifies a rare presentation of M. Fortuitum with isolated pulmonary manifestations. Our patient dealt with non-specific symptoms for years prior to the appropriate diagnosis being made. CONCLUSIONS: M. fortuitum should be considered in the differential for those with respiratory symptoms and pulmonary nodules with lymphadenopathy. Reference #1: Park et al., “Clinical Significance of Mycobacterium fortuitum isolated from respiratory specimens.” Respiratory Medicine, vol. 102, 2008, pp. 437-42. Reference #2: Wallace et al., “Spectrum of disease due to rapidly growing mycobacteria.” Reviews of Infectious Diseases, vol. 5, no. 4, 1983, pp. 657-79. DISCLOSURE: The following authors have nothing to disclose: Stephen Doyle, Matthew Exline No Product/Research Disclosure Information" @default.
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• W2765851113 date "2017-10-01" @default.
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• W2765851113 title "Diffuse Pulmonary Nodules: A Rare Infection Causing a Common Problem" @default.
• W2765851113 doi "https://doi.org/10.1016/j.chest.2017.08.196" @default.
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