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Successful Antibiotic Treatment of Mycobacterium abscessus Pulmonary Disease in an Immunocompetent Individual

Anna Beltrame, Giovanni Cattani, Maria Consuelo Screm, Federica Brillo, Maria Merelli, Claudio Scarparo, Giuseppe Como, Enrico Tortoli, Alberto Matteelli and Matteo Bassetti

 The number of subjects with Mycobacterium abscessus lung disease is increasing. The optimal treatment to prevent clinical relapse in these patients has not been well established. At times, antibiotic regimens have also been shown to produce long-term sputum conversion. We describe a case of M. abscessus  lung disease in an immunocompetent individual with successful outcome at 24 months, following antibiotic therapy. Initially, an empirical treatment was started intravenously with amikacin (700 mg once-daily), cefoxitin (4 g every 8 h), and oral clarithromycin (500 mg twice daily). Although, the symptoms resolved rapidly, the anti-mycobacterial drugs were discontinued three weeks later, following the onset of hepatotoxicity. Two weeks after discontinuation of therapy, the liver enzymes were returned to normal levels, and amikacin and clarithromycin were reintroduced and continued for another 8 months, when the individual developed hearing loss, which led to further discontinuation of antibiotic therapy. During the subsequent 24 months, broncoscopy, sputum AFB examination and mycobacterial culture were negative. Our management suggests that prompt, individualized and protracted treatment can be curative, in case of mild disease.