Letter to the Editor
Mycobacterium interjectum Lung Infection: A Case Report
Enfermedad pulmonar por Mycobacterium interjectum: a propósito de un caso
Manuel Ángel Villanueva, José Antonio Gullón
, Fernando Álvarez-Navascués
Corresponding author
Unidad de Gestión Clínica de Neumología, Hospital San Agustín, Avilés, Asturias, Spain
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"Manuel Ángel Villanueva, José Antonio Gullón, Fernando Álvarez-Navascués" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Manuel Ángel" "apellidos" => "Villanueva" ] 1 => array:4 [ "nombre" => "José Antonio" "apellidos" => "Gullón" "email" => array:1 [ 0 => "josegubl@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Álvarez-Navascués" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Neumología, Hospital San Agustín, Avilés, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad pulmonar por <span class="elsevierStyleItalic">Mycobacterium interjectum</span>: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 971 "Ancho" => 975 "Tamanyo" => 139800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT image of right upper lobe.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mycobacterium interjectum (M. interjectum)</span> is a rare, nontuberculous mycobacterium, known to cause lymphadenitis cervicalis in young patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> We report a case of pulmonary disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 52-year-old man, active smoker, presented with a 15-day history of fever, general malaise and bloody expectoration. Isolated crepitating rales were heard on lung auscultation. Chest X-ray showed right upper lobe condensation and enlarged right hilum. Treatment with levofloxacin was prescribed, but improvement was limited, so a chest computed tomography (CT) was performed, revealing condensation with air bronchogram in the posterior segment of the right upper lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and enlarged right hilar, retrocava-pretracheal and prevascular lymph nodes. Bronchoscopy was performed: gross results were normal, and cytology and bacilloscopic results from bronchial aspirate were also normal. CT-guided core biopsy of the lung was conducted, and histologic analysis of the specimen showed granulomas with multinucleated giant cells and epithelioid cell histiocytes, some of which had central necrosis. Treatment began with isoniazid, rifampicin, pyrazinamide and ethambutol. Mycobacteria were subsequently isolated from the culture of the bronchial aspirate; these were identified as <span class="elsevierStyleItalic">M. interjectum</span> using DNA technology based on inverse hybridization of PCR products targeting the 23S rRNA gene (GenoType<span class="elsevierStyleSup">®</span><span class="elsevierStyleItalic">Mycobacterium</span> CM). The patient's progress was satisfactory and, 2 months later, cultures were negative for mycobacteria. Pyrazinamide and ethambutol were withdrawn, while isoniazid and rifampicin administration continued for 1 year. At that time, the patient remained asymptomatic, with fibrous scarring and infiltration in the right upper lobe on chest X-ray. Currently, 20 months later, he is stable with no signs of disease reactivation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Only three cases of lung involvement with <span class="elsevierStyleItalic">M. interjectum</span> have been reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2–4</span></a> All three were cases of cavitary disease in which <span class="elsevierStyleItalic">M. interjectum</span> was later isolated. The strains were resistant to isoniazid, rifampicin, pyrazinamide<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and ethambutol,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> although one patient<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> initially responded well to standard antituberculosis treatment. Nevertheless, 18 months later, symptoms and radiological progression recurred, and a nontuberculous mycobacteria with the same resistance profile as before was isolated.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In contrast to the above-mentioned cases, our patient did not have cavitary disease, and response to first-line antituberculosis drugs was good, despite rifampicin and ethambutol resistance found on antimicrobial sensitivity testing. In view of the good clinical progress after identification of the mycobacteria, an antibiogram was felt to be unnecessary, and this may be considered as a limitation of our report. However, discrepancies between <span class="elsevierStyleItalic">in vitro</span> and <span class="elsevierStyleItalic">in vivo</span> resistance data raise questions regarding the real significance of <span class="elsevierStyleItalic">in vitro</span> resistance in certain situations. This issue and the long follow-up period add to the value of the experience reported.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, <span class="elsevierStyleItalic">M. interjectum</span> is a very unusual cause of lung disease. Once diagnosed, treatment with a standard antituberculosis regimen may be attempted.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villanueva MÁ, Gullón JA, Álvarez-Navascués F. Enfermedad pulmonar por <span class="elsevierStyleItalic">Mycobacterium interjectum</span>: a propósito de un caso. Arch Bronconeumol. 2015;51:155–156.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 971 "Ancho" => 975 "Tamanyo" => 139800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT image of right upper lobe.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphadenitis cervicalis due to <span class="elsevierStyleItalic">Mycobacterium interjectum</span> in immunocompetent children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Rose" 1 => "R. Kitz" 2 => "A. Mischke" 3 => "R. Enzensberger" 4 => "V. Schneider" 5 => "S. Zielen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2004" "volumen" => "93" "paginaInicial" => "424" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15124854" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic destructive lung disease associated with a novel <span class="elsevierStyleItalic">mycobacterium</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Emler" 1 => "T. Rochat" 2 => "P. Rohner" 3 => "C. Perrot" 4 => "R. Auckenthaler" 5 => "L. Perrin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.150.1.8025761" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1994" "volumen" => "150" "paginaInicial" => "261" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8025761" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium interjectum</span> as a cause of lung disease mimicking tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Martínez-Lacasa" 1 => "E. Cuchi" 2 => "R. Font" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Tuberc Lung Dis" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "1048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723389" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium interjectum</span>: a rare cause of destructive lung disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Mirant-Borde" 1 => "J. Soto" 2 => "M. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "142" "paginaInicial" => "159A" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000003/v2_201502230226/S1579212914004091/v2_201502230226/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000003/v2_201502230226/S1579212914004091/v2_201502230226/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914004091?idApp=UINPBA00003Z" ]
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