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

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From Nature Clinical Practice Rheumatology

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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.

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Figure 1: The patient's chest X-rays
Figure 2: The patient's CT images
Figure 3: Microbiological and serological parameters during the course of the patient's disease
Figure 4: A photograph of genotyping results of the patient's Mycobacterium szulgai isolates

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Authors and Affiliations

  1. and R Dekhuijzen is a Professor and Head of the Department of Pulmonary Diseases at the Radboud University, J van Ingen is a medical doctor and PhD candidate, M Boeree and W de Lange are Senior Staff Chest Physicians, Nijmegen Medical Centre. J van Ingen is also affiliated with, P de Haas is a Senior Analyst at, and D van Soolingen is the Head of, the National Mycobacteria Reference Laboratory, National Institute of Public Health and the Environment, Bilthoven. M Janssen is a Rheumatologist and E Ullmann is a Senior Staff Chest Physician in the Rijnstate Hospital in Arnhem, The Netherlands.,

    Jakko van Ingen, Martin Boeree, Matthijs Janssen, Erik Ullmann, Wiel de Lange, Petra de Haas, Richard Dekhuijzen & Dick van Soolingen

Authors
  1. Jakko van Ingen
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  2. Martin Boeree
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  3. Matthijs Janssen
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  4. Erik Ullmann
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  5. Wiel de Lange
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  7. Richard Dekhuijzen
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  8. Dick van Soolingen
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Corresponding author

Correspondence to Jakko van Ingen.

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The authors declare no competing financial interests.

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van Ingen, J., Boeree, M., Janssen, M. et al. Pulmonary Mycobacterium szulgai infection and treatment in a patient receiving anti-tumor necrosis factor therapy. Nat Rev Rheumatol 3, 414–419 (2007). https://doi.org/10.1038/ncprheum0538

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  • DOI: https://doi.org/10.1038/ncprheum0538

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