Disseminated Mycobacterium gordonae Infection in an Immunocompetent Host
Disseminated Mycobacterium gordonae Infection in an Immunocompetent Host
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DOI：
10.1097/mjt.0b013e3181e32e55
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Eskridge, Etta
中科院分区：
文献类型：
--
作者：
Asija, Amit;Prasad, Aakanksha;Eskridge, Etta
戈登分枝杆菌是一种生长缓慢的分枝杆菌，是分枝杆菌中致病性最低的。杆菌感染戈登氏菌在免疫功能低下的患者中最常见。我们提出了一个罕见的M。免疫活性个体中的戈登氏菌感染。一名37岁的女性被发现有一个肺结节在左上叶。患者否认任何呼吸道症状，包括咳嗽、咳痰、发热、胸痛或呼吸急促。患者终生不吸烟。体格检查正常。胸部计算机断层扫描（CT）显示双侧几个离散的胸膜炎性浸润。患者最初接受口服阿莫西林-克拉维酸治疗，2周后计划再次进行胸部CT扫描。实验室数据无显著性。重复CT扫描未显示任何解决方案。患者正电子发射断层扫描显示明显的高代谢摄取，累及双侧实质结节、纵隔淋巴结和脾脏。开胸术及左肺上叶结节活检显示坏死性肉芽肿性肺炎伴罕见的抗酸杆菌。培养物为M阳性。戈登。根据药物敏感性，患者开始接受阿奇霉素、利福平和环丙沙星的多药方案治疗12个月。治疗后重复CT扫描和正电子发射断层扫描显示完全消退。患者在治疗后5年一直保持无病状态。而不是总是拒绝M。戈登氏菌作为一种污染物，我们应该包括在我们的鉴别诊断肺部感染的免疫功能正常和免疫功能低下的主机。对M.人类戈登氏菌感染
Mycobacterium gordonae is a slow-growing mycobacterium that is the least pathogenic of the mycobacteria. Infection with M. gordonae is most commonly reported in immunocompromised patients. We present a rare case of M. gordonae infection in an immunocompetent individual. A 37-year-old woman was found to have a pulmonary nodule in the left upper lobe. The patient denied any respiratory symptoms, including cough, sputum production, fever, chest pain, or shortness of breath. The patient was a lifetime nonsmoker. Physical examination was normal. Computed tomography (CT) scan of the chest revealed several discrete pleural-based inflammatory infiltrates bilaterally. The patient was treated with oral amoxicillin-clavulinic acid initially and a repeat CT scan chest was scheduled after 2 weeks. Laboratory data were nonsignificant. Repeat CT scan did not show any resolution. Patient positron emission tomography scan revealed marked hypermetabolic uptake involving bilateral parenchymal nodules, mediastinal lymph nodes, and the spleen. A thoracotomy with biopsy of the left upper lobe nodule revealed necrotizing granulomatous pneumonitis with rare acid-fast bacilli. Cultures were positive for M. gordonae. The patient was started on a multidrug regimen of azithromycin, rifampin, and ciprofloxacin, based on drug sensitivities, for 12 months. Repeat CT scan and positron emission tomography scan after treatment showed complete resolution. The patient has remained disease-free 5 years after treatment. Instead of always dismissing M. gordonae as a contaminant, we should include it in our differential diagnosis of pulmonary infection in both immunocompetent and immunocompromised hosts. Further studies are needed to understand the pathogenesis of M. gordonae infection in humans.