Successful treatment of pneumonia due to Mycobacterium goodii in a severely underweight 45-year-old woman: case report and review of literature.

Mycobacterium goodii is a rapidly growing non-tuberculous mycobacterium (NTM), primarily associated with wound and prosthetic infections. Pulmonary infections are rare, typical of patients with predisposing conditions. We report a case of M.goodii pneumonia a severely underweight (BMI 13.8 kg/m 2 ) 45-year-old woman with restrictive eating behavior and self-induced vomiting. She presented with progressive dyspnea, fever, functional decline, neutrophilia and elevated C-reactive protein. Chest CT showed segmental pulmonary embolism and bilateral lower lobe consolidations with lipoid features. Despite empirical broad-spectrum antibiotics, respiratory failure worsened. Bronchoalveolar lavage (BAL) yielded a rapidly growing mycobacterium, later identified as M. goodii. Initial treatment with imipenem and clarithromycin led to clinical and radiological improvement. Based on susceptibility testing, definitive oral therapy with minocycline, ethambutol, and moxifloxacin was administered for 18 months, with progressive radiologic resolution and significant weight gain. Therapy was discontinued upon clinical recovery and imaging stability. The patient remained asymptomatic during long-term follow-up. This rare case of M.goodii pneumonia in a severely malnourished patient, possibly facilitated by aspiration, suggests that NTM should be considered in the differential diagnosis of non-resolving pneumonia in patients with restrictive eating behavior. Treatment should be guided by susceptibility testing and may require prolonged duration. • Mycobacterium goodii can cause pneumonia in severely underweight patients • Case linked to restrictive eating disorder and chronic aspiration • Diagnosis required BAL and molecular identification via DNA sequencing • Prolonged therapy based on susceptibility testing led to full recovery