Pleural effusion in an immunocompetent woman caused by Mycobacterium fortuitum

Abstract

Mycobacterium fortuitum is a non-tuberculous mycobacterium that can cause pneumonia, abscess and empyema in subjects with predisposing lung diseases. However, pleurisy with effusion is rare. Herein, we report the case of a 74-year-old immunocompetent female patient without apparent risk factors, who suffered haemorrhagic pleural effusion as the main clinical manifestation. Pleural nodules were detected by computed tomography scan, and microbiological analysis revealed M. fortuitum in the absence of other pathogens. The patient was treated with ceftriaxone and ciprofloxacin, and full recovery ensued in 4 weeks. To our knowledge, this is the first reported case of haemorrhagic pleural effusion in an immunocompetent patient without underlying diseases. Although non-tuberculous mycobacterial infections are rarely accompanied by pleural involvement, M. fortuitum should be considered in such cases, especially when microbiology fails to detect the usual pathogens, and when the clinical picture is unclear.

Successful Treatment of <i>Aspergillus</i> Empyema Using Open Window Thoracostomy Salvage Treatment and the Local Administration of an Antifungal Agent

“…M. avium was first isolated from the patient's pleural effusion. Although NTM-induced empyema has rarely been reported (8)(9)(10), some cases have been successfully treated with surgical therapy (11). We decided to perform a right lower lobectomy, as it was difficult to administer conservative management using antibiotics and chest tube drainage.…”

Misidentification ofMycobacterium fortuitumin an immunocompetent patient presenting with a unilateral neck mass

“…Alternative, if not cheaper, methods of identification include incubation in a radiometric automated Becton Dickinson culture system 20. Typically in such instances identification of M fortuitum is predicated on its ability to grow in p -nitrobenzoic acid and MacConkey's agar 20.…”

“…Typically in such instances identification of M fortuitum is predicated on its ability to grow in p -nitrobenzoic acid and MacConkey's agar 20. Its inability to form any pigment on Löwenstein-Jensen medium; tolerance to 5% NaCl; positive nitrate reduction; and positive arylsulfatase test are also crucial defining characteristics 20. However, these are not always accurate 19…”

“…M fortuitum , as with most rapidly growing NTM, is resistant to standard antituberculous drugs 20. However, these organisms are known to be sensitive to cephalosporins, amikacin, ciprofloxacin, clarithromycin and imipenem 20 21.…”

“…However, these organisms are known to be sensitive to cephalosporins, amikacin, ciprofloxacin, clarithromycin and imipenem 20 21. With regard to the optimum management of M fortuitum infections, the American Thoracic Society recommends surgical intervention and antimicrobial therapy for a minimum period of 4 months to achieve a high likelihood of cure; antibiotic therapy alone is often associated with recurrences, chronic drainage and sinus tract formation 21.…”