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Nat Clin Pract Rheumatol. 2007 Jul;3(7):414-9.

Pulmonary Mycobacterium szulgai infection and treatment in a patient receiving anti-tumor necrosis factor therapy.

Author information

1
Department of Pulmonary Diseases, Radboud University, Nijmegen Medical Centre, and the Rijnstate Hospital in Arnhem, The Netherlands. j.vaningen@ulc.umcn.nl

Abstract

BACKGROUND:

A 54-year-old man with a 22-year history of rheumatoid arthritis and an 8-year history of chronic obstructive pulmonary disease presented with dyspnea on exertion, nonproductive cough and fatigue of 1 month's duration. His medication at presentation consisted of etanercept, azathioprine, naproxen and inhaled fluticasone and salbutamol.

INVESTIGATIONS:

At presentation, the patient underwent physical examination, chest X-ray and high-resolution CT, blood tests, and bronchoalveolar lavage fluid analysis including auramine stains and gene sequence analysis of cultured Mycobacterium szulgai. The patient underwent minithoracotomy after 6 months, and bronchoalveolar lavage fluid analysis, culture and chest X-ray after 18 months. Further chest imaging and culture of sputum samples were performed another year later.

DIAGNOSIS:

Pulmonary M. szulgai infection.

MANAGEMENT:

Triple drug therapy with rifampicin, ethambutol hydrochloride and clarithromycin. Anti-tumor necrosis factor treatment was continued.

PMID:
17599076
DOI:
10.1038/ncprheum0538
[Indexed for MEDLINE]

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