CRA57 DIAGNOSTIC CHALLENGE AND SUCCESSFUL MANAGEMENT OF MYCOBACTERIUM ABSCESSUS PULMONARY DISEASE IN A PATIENT WITH PRIOR PULMONARY TUBERCULOSIS HISTORY

Kamal Rudy Ieqraque bin Mohammad Zain, Zul Amali bin Che Kamaruddin, Suzila binti Che Sayuti
Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan

Introduction:

Non-tuberculous mycobacteria pulmonary disease (NTM-PD) is a growing concern globally, posing diagnostic and therapeutic challenges. This case report highlights the complexities in diagnosing and managing NTM-PD, particularly Mycobacterium abscessus complex (MABC), in a patient initially treated for pulmonary tuberculosis (PTB).

Case Presentation:

A 69-year-old Malay woman with a history of passive smoking and resolved PTB presented with recurrent hemoptysis. Initial investigations suggested PTB with bronchiectasis, but sputum and bronchoalveolar lavage cultures revealed MABC. Imaging revealed right hilar lymphadenopathy, cicatrization atelectasis, and bronchiectasis. A bronchoscopy identified and removed a right middle lobe endobronchial lesion.

Management and Outcome:

Treatment for MABC was initiated with amikacin, clarithromycin, and clofazimine after susceptibility testing. Amikacin was discontinued after 3.5 months due to completion of therapy. Repeat cultures were negative, indicating treatment response. The patient continued clarithromycin and clofazimine with plans to complete the course in December 2024.

Conclusion:

This case emphasizes the importance of considering NTM-PD in patients with persistent respiratory symptoms and a history of PTB. Early diagnosis and appropriate treatment are crucial to prevent disease progression and improve outcomes.