Cases of pulmonary Mycobacterium szulgai Infection Leading to Pneumothorax and spontaneous Remission

Case Details

Disease Location

Lungs, bronchioles

Personal Characteristics

86-year-old man, an ex-smoker. He had no history of pulmonary tuberculosis

Clinical Characteristics

Presented with dyspnea and fever. White blood cell count was 16,290/l and c-reactive protein level was 16.22 mg/dl chest x-ray and computed tomography (CT) showed pulmonary infiltration with an air bronchogram and bronchiectasis in the right upper lobe and right pneumothorax with pleural effusion pleural fluid analysis revealed a neutrophil-predominant (64%) exudate, with 117 mg/dl glucose, 770 iu/l lactate dehydrogenase, and 57.2 u/l adenosine deaminase. Initial blood and pleural fluid cultures were negative for bacterial and mycobacterial organisms. Initial sputum culture was negative for bacterial organisms but positive for m. Szulgai, which was identified using a DNA-DNA hybridization method empirical antibiotic treatment with 1 g cefozopran twice daily was started and thoracic drainage was performed. The second sputum culture was negative for bacterial organisms but positive for m. Szulgai. Furthermore, the second pleural fluid culture was positive for mycobacterial organisms; however, no particular species could be identified. Ciprofloxacin was continued for 1 week, and chest x-ray showed improvement in pleural effusion 1 month post-admission

Remission Characteristics

Chest x-ray showed improvement in pleural effusion 1 month post-admission two months later, repeat chest x-ray showed further improvement in pleural effusion; however, infiltration and bronchiectasis persisted

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Did not respond to oral levofloxacin thoracentesis. Cefozopran (1g c/12h) ciprofloxacin