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

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

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea. kumc92@naver.com
  • 2Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
  • 3Department of Pulmonary and Critical Care Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.

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

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

  • 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.

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


Reference

1. Park YS, Lee CH, Lee SM, Yang SC, Yoo CG, Kim YW, et al. Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea. Int J Tuberc Lung Dis. 2010. 14:1069–1071.
2. van Ingen J, Boeree MJ, de Lange WC, de Haas PE, Dekhuijzen PN, van Soolingen D. Clinical relevance of Mycobacterium szulgai in the Netherlands. Clin Infect Dis. 2008. 46:1200–1205.
3. Koh WJ, Kwon OJ, Lee KS. Diagnosis and treatment of nontuberculous Mycobacterial pulmonary diseases: a Korean perspective. J Korean Med Sci. 2005. 20:913–925.
4. Marks J, Jenkins PA, Tsukamura M. Mycobacterium szulgai--a new pathogen. Tubercle. 1972. 53:210–214.
5. Benator DA, Kan V, Gordin FM. Mycobacterium szulgai infection of the lung: case report and review of an unusual pathogen. Am J Med Sci. 1997. 313:346–351.
6. Maloney JM, Gregg CR, Stephens DS, Manian FA, Rimland D. Infections caused by Mycobacterium szulgai in humans. Rev Infect Dis. 1987. 9:1120–1126.
7. Shenai S, Rodrigues C, Mehta A. Time to identify and define non-tuberculous mycobacteria in a tuberculosis-endemic region. Int J Tuberc Lung Dis. 2010. 14:1001–1008.
8. Alvarez-Uria G. Lung disease caused by nontuberculous mycobacteria. Curr Opin Pulm Med. 2010. 16:251–256.
9. Koh WJ, Kwon OJ, Yu CM, Jeon KM, Suh GY, Chung MP, et al. Recovery rate of nontuberculous Mycobacteria from acid-fast-bacilli smear-positive sputum specimens. Tuberc Respir Dis. 2003. 54:22–32.
10. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007. 175:367–416.
11. Kim JH, Suh JT, Park SY, Lee HJ, Lee WI. Clinical evaluation of 10 cases of nontuberculous Mycobacteria isolated from sputum. Korean J Lab Med. 2004. 24:49–52.
Full Text Links
  • TRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr