Pulmonary <i>Mycobacterium parascrofulaceum</i> Infection in a Patient with Chronic Progressive Pulmonary Aspergillosis: A Case Report and Literature Review

Abstract

A 67-year-old man with a pulmonary cavity was admitted to our hospital. Mycobacterial culture of the bronchoalveolar lavage fluid sample obtained from the right upper pulmonary lesion tested positive for mycobacterium, and sequencing of the 16S rRNA genes, hsp65, and rpoB revealed that the cultured mycobacterium was Mycobacterium parascrofulaceum. Treatment with antimycobacterial agents was ineffective, and repeated culturing of bronchoscopic specimens revealed that the specimens were positive for Aspergillus fumigatus. Combination treatment of antimycobacterial agents and voriconazole improved the lung lesion. This is the first report of a patient with pulmonary M. parascrofulaceum infection complicated with chronic progressive pulmonary aspergillosis.

Evaluation and clinical impact of MALDI Biotyper Mycobacteria Library v6.0 for identification of nontuberculous mycobacteria by MALDI‐TOF mass spectrometry

“…The ability of MALDI‐TOF MS to identify M. parascrofulaceum would not change the choice of antimicrobials. Although there is no recommended optimal treatment for M. scrofulaceum , a macrolide (clarithromycin or azithromycin) combined with one or two other in vitro active drugs (e.g., a later generation fluoroquinolone, linezolid, amikacin, and a rifamycin with or without ethambutol) appears to be the favorable approach, similarly as for M. parascrofulaceum 32–34 . However, M. parascrofulaceum was first reported in 2004 by Turenne et al, 35 and only a few cases were documented thus far.…”

“…Although there is no recommended optimal treatment for M. scrofulaceum, a macrolide (clarithromycin or azithromycin) combined with one or two other in vitro active drugs (e.g., a later generation fluoroquinolone, linezolid, amikacin, and a rifamycin with or without ethambutol) appears to be the favorable approach, similarly as for M. parascrofulaceum. [32][33][34] However, M. parascrofulaceum was first reported in 2004 by Turenne et al, 35 and only a few cases were documented thus far. Although cutaneous infection in a patient without immunosuppression was also described, this species typically causes respiratory diseases, especially in elderly immunosuppressed patients with predisposing factors.…”