Pulmonary Mycobacterium abscessus disease in a patient receiving low-dose methotrexate for treatment of early rheumatoid arthritis

<i>Mycobacterium abscessus</i> Pulmonary Infection under Treatment with Tocilizumab

“…Because CAM monotherapy rapidly leads to acquired resistance and treatment failure, the use of a multi-drug regimen including CAM with AMK plus CXT or IPM/CS is recommended (5, 6). Mori et al also highlighted the importance of early isolation and identification of the causative NTM species in cases of M. abscessus infection (14). Recently, testing for anti-GPL-core antibodies has become commercially available.…”

“…Because M. massiliense cannot be distinguished from M. abscessus using traditional methods (23), there is a possibility that the infection in our patient may have been caused by M. massiliense. The development of a convenient phenotyping method and treatment regimens tailored to each species is desirable in the fu- (14). In the current case, we discontinued the dose of MTX because the patient's productive cough and hemosputum continued despite the withdrawal of TCZ.…”

“…These RA patients included two individuals who had been treated with TNF antagonists (11,12) and two who had not been treated with biological DMARDs (13,14). Two of these four cases were fatal (11,13).…”