Tuberc Respir Dis.  2012 Jan;72(1):55-58.

A Case of Mycobacterium szulgai Lung Disease in Patient with Healed Tuberculosis

• Lee EJ
• Park JY
• Kim EY
• Choi J
• Kim HS
• Chung SW
• Yoo JH
• Choi CW
• Kim GY
• Lee JH
• Kim YH

Abstract

Mycobacterium szulgai is a rare nontuberculous mycobacterium found in Korea. It is an opportunistic pathogen and is usually isolated from patients with a history of alcoholism, chronic pulmonary disease, or an immunocompromising condition. We present here a case of M. szulgai isolated from a patient with a history of pulmonary tuberculosis. A 54-year-old man was admitted with dyspnea and febrile sensation. He had a history of pulmonary tuberculosis which occurred 30 years earlier and treatment with anti-tuberculosis medication. His chest computed tomography scan showed cavitary consolidation in both upper lungs. A sputum acid-fast bacilli (AFB) smear was positive and anti-tuberculous medication was started. However, a polymerase chain reaction for mycobacterium tuberculosis was negative and anti-tuberculous medication was stopped. M. szulgai was isolated on 3 separate sputum and bronchial wash fluid AFB cultures. He was treated with clarithromycin, rifampicin, and ethambutol. After 1 month, a sputum AFB smear and culture became negative and no additional M. szulgai were isolated during a 16-month treatment.

Keyword

Nontuberculous Mycobacteria; Chronic Necrotizing Pulmonary Aspergillosis

MeSH Terms

Alcoholism
Clarithromycin
Dyspnea
Ethambutol
Humans
Invasive Pulmonary Aspergillosis
Korea
Lung
Lung Diseases
Middle Aged
Mycobacterium
Mycobacterium tuberculosis
Nontuberculous Mycobacteria
Polymerase Chain Reaction
Rifampin
Sensation
Sputum
Thorax
Tuberculosis
Tuberculosis, Pulmonary
Clarithromycin
Ethambutol
Rifampin

Figure

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  Figure 1 The initial chest X-ray showing destroyed lung lesions. Multifocal cystic lesions and consolidations are also seen.

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  Figure 2 The initial chest CT showing wall thickening of cavitary lesion in left upper lobe and peribronchial air space consolidation in right lung. CT: computed tomography.

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  Figure 3 The follow-up chest X-ray after 16 months of treatment (treatment completion). Decreased extent of consolidation and cavitary lesion are seen.

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