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rare mycobacterium - pulmonary infection
Mar 22, 2002

Several months ago my partner was diagnosed with a lung infection - mycobacterium interjectum (this is not a typo - M. interjectum was the only mycobacterium cultured on two separate bronchoscopies). She is a perfectly healthy (HIV negative) 42 year old woman, non-smoker, no underlying pulmonary disease. She presented with one minor episode of hemoptysis nine months ago. Cat scans revealed small airways disease (patchy infiltrate.) The second cat scan showed it was larger. She has no symptoms whatsoever. She has been treated almost four months with Biaxin. She has had briefly, and sequentially, also taken Rifabutin, Cipro, and Ethambutol, but had bad reactions to the Rifabutin and Cipro, and sensitivity tests revealed that ethambutol is not effective with this bacterium. An x-ray last week appeared normal (hooray!), but she has not had a repeat cat scan. She produces no sputum, and hasn't had another bronchoscopy yet. How much longer do you think she needs to be treated? Her doctor wants to add Clofazimine, but it sounds pretty nasty. Any thoughts?

Response from Dr. Feinberg

I'm glad she appears to have responded, but I would be more reassured if a repaet CAT scan aalso showed improvement since that is a more sensitive test than a chest X-ray. I am anxious about any single-drug regimen for any atyoical mycobacterium In my experience, clofazimine is not such a tough drug to take. There may be alterntives; it sounds like susceptibiity testing has laready been done to see what drugs will work and which ones won't. Sometimes, an injectable (IV) drug called amikacin is useful


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