Case Report

Nine-Year Progression of Untreated Pulmonary Mycobacterium szulgai Infection

Authors: Kanwal Randhawa, MD, Peter Smethurst, MD, Guy W. Soo Hoo, MD, MPH

Abstract

A 58-year-old man was seen with complaints of fevers, night sweats, weight loss, and multiple bilateral cavitary lung lesions. Mycobacterium szulgai with nearly identical antibiograms grew from separate sputum specimens 9 years apart. He was treated with a combination of clarithromycin and ethambutol with clinical, microbiologic, and radiographic resolution of disease. This is the longest untreated case of documented Mycobacterium szulgai infection reported, and offers a glimpse of its natural history when left untreated. Despite an infrequent isolation (<0.5% of cases), it is a pathogenic organism which warrants treatment.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Griffith DE, Aksamit T, Brown-Elliott BA, et al; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007;175:367–416.
 
2. Schaefer WB, Wolinsky E, Jenkins PA, et al. Mycobacterium szulgai-a new pathogen. Serologic identification and report of five new cases. Am Rev Respir Dis 1973;108:1320–1326.
 
3. Davidson PT. Mycobacterium szulgai; a new pathogen causing infection of the lung. Chest 1976;69:799–801.
 
4. Tortoli E, Besozzi G, Lacchini C, et al. Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature. Eur Respir J 1998;11:975–977.
 
5. Sánchez-Alarcos JM, De Miguel-Díez J, Bonilla I, et al. Pulmonary infection due to Mycobacterium szulgai. Respiration 2003;70:533–536.
 
6. Dylewski JS, Zackon HM, Latour AH, et al. Mycobacterium szulgai: an unusual pathogen. Rev Infect Dis 1987;9:578–580.
 
7. Maloney JM, Gregg CR, Stephens DS, et al. Infections caused by Mycobacterium szulgai in humans. Rev Infect Dis 1987;9:1120–1126.
 
8. Marks J, Jenkins PA, Tsukamura M. Mycobacterium szulgai—a new pathogen. Tubercle1972;53:210–214.
 
9. Benator DA, Kan V, Gordin FM. Mycobacterium szulgai infection of the lung: case report and review of an unusual pathogen. [Review]. Am J Med Sci 1997;313:346–351.
 
10. Zhang Q, Kennon R, Koza MA, et al. Pseudoepidemic due to a unique strain of Mycobacterium szulgai: genotypic, phenotypic, and epidemiological analysis. J Clin Microbiol 2002;40:1134–1139.
 
11. van Ingen J, Boeree MJ, de Lange WC, et al. Clinical relevance of Mycobacterium szulgai in The Netherlands. Clin Infect Dis 2008;46:1200–1205.
 
12. Brown BA, Wallace RJ Jr, Onyi GO. Activities of clarithromycin against eight slowly growing species of nontuberculous mycobacteria, determined by using a broth microdilution MIC system. Antimicrob Agents Chemother 1992;36:1987–1990.