Pulmonary disease caused by Mycobacterium abscessus: a case report

Abstract

Mycobacterium abscessus is a species of nontuberculous mycobacteria that accounts for 80% of rapidly growing mycobacterial infections. The lung disease associated with it, although rare, has had an increased incidence in Costa Rica in recent years, being evident in 1.19 out of 10 cases of mycobacteria in 2018. The majority of patients are non-smokers, without documented lung disease, and some with a history of having received previous anti-tuberculous treatment, which is considered a risk factor for the development of lung disease due to M. abcessus. Its symptoms can vary from asymptomatic to severe bronchiectasis and cavitary lung disease, with significant morbidity and mortality and its diagnosis requires compliance with defined clinical, radiological and microbiological criteria. Clinical suspicion is vital for diagnosis, as well as culture and species identification for proper treatment. Its treatment is prolonged, up to a year and with multiple medications. We present the case of a 60-year-old male patient who meets the proposed diagnostic criteria for pulmonary disease caused by Mycobacterium abscessus, who received in-hospital treatment with linezolid, amikacin, and clarithromycin for 30 days, continuing out-of-hospital management for one year with linezolid, doxycycline, clarithromycin and trimethoprim sulfamethoxazole orally; with which he evolves satisfactorily. Few clinical trials have been developed to propose a specific treatment scheme to be followed as the optimal therapeutic regimen.