Abstract
Cases of nontuberculous Mycobacterium (NTM) are on the rise across North America. This is the first clinical description of a 31-year old male patient in North America with Mycobacterium kansasii who met DSM-5 diagnostic criteria for anorexia nervosa (AN) and obsessive compulsive disorder (OCD), and who was engaged in specialized outpatient treatment of an eating disorder. The patient did not disclose at intake assessment that he was experiencing symptoms of a persistent cough, blood in his sputum, or that he was simultaneously being assessed outside of the eating disorders program for NTM until he had a positive smear for Mycobacterium kansasii in March 2017. The patient made progress in treatment in his weight status and some psychological symptoms despite the concurrent NTM symptoms. However, later treatment attendance was negatively impacted by the side effects of his medication regime for NTM and careful follow-up was required to monitor for potential interactions between his treatment for NTM and psychiatric medication. This case report provides an initial window into clinicians’ ability to treat a patient with a concurrent eating disorder and an NTM infection and lessons learned in the process.
Level of evidence
Level V: Opinions of respected authorities, based on descriptive studies, clinical experience, or reports of expert committees.
References
Khan K, Wang J, Marras TK (2007) Nontuberculous mycobacterial sensitization in the United States: national trends over three decades. Am J Respir Crit Care Med 176(3):306–313. https://doi.org/10.1164/rccm.200702-201OC
Hsu PY, Yang YH, Hsiao CH, Lee PI, Chiang BL (2002) Mycobacterium kansasii infection presenting as cellulitis in a patient with systemic lupus erythematosus. J Formos Med Assoc 101(8):581–584
Maliwan N, Zvetina JR (2005) Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience. Postgrad Med J 81(958):530–533. https://doi.org/10.1136/pgmj.2004.026229
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing, Arlington
Suzuki Y, Nozaki Y, Nakanishi K, Konoh T, Yoshimoto T, Nishiwaki K (2005) A rare case of disseminated Mycobacterium kansasii infection. Kekkaku (Tuberculosis) 80(4):359–364
Alhanna J, Purucker M, Steppert C, Daborn AG, Schiffel G, Gruber H, Borgmann S (2012) Mycobacterium chimaera causes tuberculosis-like infection in a male patient with anorexia nervosa. Int J Eat Disord 45(3):450–452. https://doi.org/10.1002/eat.20942
Fairburn CG (2008) Cognitive behavior therapy and eating disorders. Guilford, New York
Mac Neil BA, Leung P, Montemarano V (2018) Exposure with response prevention (ERP) or body dissatisfaction in a group therapy format: an exploratory study. Eat Weight Disord 23(2):225–232. https://doi.org/10.1007/s40519016-0340-2
Beck A, Epstein N, Brown G, Steen R (1988) An inventory for measuring clinical anxiety: psychometrics properties. J Consult Clin Psychol 56(6):893–897. https://doi.org/10.1037//0022-006X.56.6.893
Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio
Smith KE, Mason TB, Murray SB, Griffiths S, Leonard RC, Wetterneck CT, Smith BE, Farrell NR, Riemann BC, Lavender JM (2017) Male clinical norms and sex differences on the eating disorder inventory (EDI) and eating disorder examination questionnaire (EDE-Q). Int J Eat Disord 50(7):769–775. https://doi.org/10.1002/eat22716
Roberts ME, Barthel FMS, Lopez C, Tchanturia K, Treasure JL (2011) Development and validation of the Detail and Flexibility Questionnaire (DFlex) in eating disorders. Eat Behav 12:168–174. https://doi.org/10.1016/j.eatbeh.2011.04.001
Allende LM, Rubio I, Guillen-Perales J, Zamora J, Moscoso J, Moreno A, Garcia-perez MA, Varela P, Arnaiz-villena A (2000) Immunodeficiency associated with anorexia nervosa is secondary and improves after refeeding. Tissue Antigens 55:38
Dalton B, Bartholdy S, Robinson L, Solmi M, Ibrahim M, Breen G, Schmidt U, Himmerich H (2018) A meta-analysis of cytokine concentrations in eating disorders. J Psychiatr Res 103:252–264. https://doi.org/10.1016/j.jpsychires.2018.06.002
Griffiths S, Mond JM, Li Z, Gunatilake S, Murray SB, Sheffield J, Touyz S (2015) Self-stigma of seeking treatment and being male predict an increased likelihood of having an undiagnosed eating disorder. Int J Eat Disord 48:775–778. https://doi.org/10.1002/eat.22413
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All of the authors collected clinical data, wrote the manuscript, and approved the final version for submission. Parts of this work have been presented at the 2018 International Conference on Eating Disorders (ICED) and 2018 Eating Disorders Association of Canada (EDAC) conference.
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This article is part of Topical Collection on Males and eating and weight disorders.
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MacNeil, B.A., Hudson, C.C., Nadkarni, P. et al. A case report of a male patient receiving treatment for anorexia nervosa and comorbid obsessive compulsive disorder who was later diagnosed with nontuberculosis Mycobacterium. Eat Weight Disord 26, 1691–1695 (2021). https://doi.org/10.1007/s40519-020-00967-8
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DOI: https://doi.org/10.1007/s40519-020-00967-8