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Pulmonary Mycobacterium szulgai infection and treatment in a patient receiving anti-tumor necrosis factor therapy.

van Ingen J, Boeree M, Janssen M, Ullmann E, de Lange W, de Haas P, Dekhuijzen R, van Soolingen D

Department of Pulmonary Diseases, Radboud University, Nijmegen Medical Centre, and the Rijnstate Hospital in Arnhem, The Netherlands. j.vaningen@ulc.umcn.nl

BACKGROUND: A 54-year-old man with a 22-year history of rheumatoid arthritis and an 8-year history of chronic obstructive pulmonary disease presented with dyspnea on exertion, nonproductive cough and fatigue of 1 month's duration. His medication at presentation consisted of etanercept, azathioprine, naproxen and inhaled fluticasone and salbutamol. INVESTIGATIONS: At presentation, the patient underwent physical examination, chest X-ray and high-resolution CT, blood tests, and bronchoalveolar lavage fluid analysis including auramine stains and gene sequence analysis of cultured Mycobacterium szulgai. The patient underwent minithoracotomy after 6 months, and bronchoalveolar lavage fluid analysis, culture and chest X-ray after 18 months. Further chest imaging and culture of sputum samples were performed another year later. DIAGNOSIS: Pulmonary M. szulgai infection. MANAGEMENT: Triple drug therapy with rifampicin, ethambutol hydrochloride and clarithromycin. Anti-tumor necrosis factor treatment was continued.

Published 29 June 2007 in Nat Clin Pract Rheumatol, 3(7): 414-9.
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