CRA52 UNRAVELLING THE COMPLEXITY: A UNIQUE CASE OF MYCOBACTERIUM CHIMAERA LUNG INFECTION AND PULMONARY PENICILLIOSIS CO-INFECTION IN A GERIATRIC PATIENT

T Abdul Aziz1, UN Daut1
1University Putra Malaysia, Selangor, Malaysia

Introduction:

Non-tuberculous mycobacterial disease with pulmonary penicilliosis co-infection in geriatric patients is a complex clinical scenario requiring comprehensive clinical evaluation and optimal therapeutic strategies. 

Case report: We present a case of a 74-year-old female who was previously well, initially came with status epilepticus due to severe hyponatremia. An initial CT scan showed no evidence of meningoencephalitis. She was treated with broad-spectrum antibiotic for community-acquired pneumonia, as evident in chest x-ray. Severe hyponatremia was treated with hypertonic saline. Later, her tracheal aspirate and sputum cultures revealed Mycobacterium avium complex M. chimaera. CT thorax showed a pattern of nodular bronchiectasis over the right middle lobe and lingula segment. The bronchoalveolar lavage result revealed the presence of Penicillium species. The culture for Mycobacterium tuberculosis was negative. Treatment for M. chimaera and pulmonary penicilliosis was commenced. Clarithromycin, rifampicin, and erythromycin with IV amikacin twice per week was the regime . However, the patient was not tolerating treatment for non-tuberculous mycobacterium infection after a month. She had severe nausea and poor appetite, and so treatment was stopped. The patient was recovering well on clinic follow ups after completed antifungal treatment with IV Amphotericin B and oral voriconazole for a total of 8 weeks duration. 

Discussion:

Treatment of severe co-infection in geriatric patients, especially non-tuberculous mycobacterial disease, requires a tailored approach to minimise side effects and achieve optimal therapeutic outcomes while considering the unique challenges associated with ageing.