Abstract Introduction Mycobacterium kansasii is a nontuberculous mycobacterium (NTM) that is a significant pathogen causing pulmonary disease in immunocompetent adults with underlying lung conditions. It often mimics tuberculosis and presents with symptoms such as productive cough, weight loss, fatigue, and cavitary lesions predominantly in the upper lobes. Chronic pulmonary aspergillosis (CPA) has been reported to develop as a complication, creating a complex condition that requires careful diagnosis and management. Description A 65-year-old male with chronic obstructive pulmonary disease (COPD), bronchiectasis, and cavitary lung lesions secondary to M. kansasii—who had completed treatment with rifampin, ethambutol, and isoniazid—was admitted to the hospital for a COPD exacerbation. The patient reported that his respiratory symptoms had initially begun two years earlier, with recurrent admissions for COPD exacerbations and respiratory infections requiring intravenous antibiotics.On presentation, he was malnourished, afebrile, and normotensive, requiring supplemental oxygen via nasal cannula. Laboratory results demonstrated neutrophil-predominant leukocytosis, normocytic anemia, and metabolic alkalosis. Computed tomography angiography of the chest demonstrated multifocal bilateral cavitary lesions with surrounding consolidation and a large left apical cavity with internal debris and severe bronchiectasis (Figure 1). Respiratory sputum cultures obtained on admission were positive for Klebsiella pneumoniae and Aspergillus fumigatus. Serum IgE levels and Aspergillus galactomannan antigen were markedly elevated.The patient was started on cefepime for treatment of Klebsiella pneumoniae and voriconazole for treatment of aspergillosis. A close outpatient follow-up was arranged upon discharge, as treatment requires serial clinical assessments and radiographic imaging to monitor response. Discussion Aspergillus and Mycobacterium species are opportunistic pathogens that can cause severe pulmonary disease, and co-infection with both carries a poor prognosis (Naito et al., 2018; Takeda et al., 2016). It is recognized that chronic pulmonary aspergillosis (CPA) can develop in NTM infections, especially in the fibrocavitary subtype. Mycobacterial pulmonary infection is one of the most common underlying conditions associated with CPA. Awareness of the risk factors is important when determining treatment strategies, especially in patients with NTM lung disease, as the coexistence of both infections has worse outcomes. It is essential to recognize and screen for CPA in patients diagnosed with NTM to facilitate early treatment. Risk factors such as older age, male sex, low body mass index, chronic obstructive lung disease, systemic corticosteroid use, Mycobacterium abscessus complex infection, and the cavitary form of NTM lung disease remain significant predictors of CPA development (Jhun et al., 2021; Fukushima et al., 2021). This abstract is funded by: None
Pelekhach et al. (Fri,) studied this question.