C68-27 Shaking off the Diagnostic Dust: A Case Report of Nontuberculous Mycobacteria in a World Trade Center Disaster Responder

Introduction Existing literature has highlighted the association between exposure to the World Trade Center (WTC) disaster in 2001 and pulmonary pathologies, most notably lung cancer, obstructive lung disease, and interstitial lung disease. However, there is scarce data on nontuberculous Mycobacteria (NTM) infections in such individuals. The following case highlights a WTC disaster responder with clinical, laboratory, and radiographic findings suggestive of infectious lung disease who was ultimately diagnosed with NTM and successfully treated with antimicrobial therapy. Case Overview A 71-year-old male with past medical history most significant for childhood asthma, environmental allergies, and mild bronchiectasis had worsening of his respiratory symptoms following the WTC disaster during which he was exposed to dust and debris without personal protective equipment. He reported significant dyspnea on exertion, chronic cough productive of yellow-green sputum, and bilateral chest pains. He had no weight loss, fevers, chills, or night sweats. Chest CT scans revealed waxing and waning nodular, tree-in-bud, and ground glass opacities. PET-CT confirmed none were hypermetabolic. Sweat chloride testing was negative and cardiac evaluation, including cardiac catheterization and stress echocardiogram, was unremarkable. Aspergillus antibodies were negative, and total eosinophil count was normal. Serum IgE levels were elevated (594 [IU]/mL.) Spirometry was repeatedly normal with no post-bronchodilator changes. He underwent multiple cultures for acid-fast bacilli which grew NTM including Mycobacterium gordonae, xenopi, and intracellulare. He began treatment with ethambutol, rifampin, and azithromycin, which resulted in improved dyspnea, greater exercise tolerance, and decreased mucous burden. Post-treatment sputum cultures continue to show no growth. Discussion This case demonstrates that NTM infection may be an important diagnostic consideration in WTC disaster survivors and responders along with other better-studied pulmonary diseases. NTM is commonly found in dust and soil, which many survivors of and responders to the disaster had inhalational exposure to. Thus, presence at the WTC disaster and its aftermath should be further explored as a risk factor for NTM infection. This population is an at-risk group who may benefit from earlier chest imaging and sputum analysis when experiencing chronic respiratory symptoms that cannot be attributed to any other diagnosis. This abstract is funded by: None