Abstract Introduction Pulmonary Mycobacterium avium complex (MAC) infection presents a growing challenge due to complex management. Treatment requires prolonged multidrug regimens that often cause adverse effects, leading to poor adherence and reduced quality of life. Despite this, the full impact on patients’ daily functioning and well-being is underestimated. This case illustrates a 26-year history of treatment intolerance and its effect on a patient’s life. Case Presentation A 49-year-old woman presented to the primary care clinic with a chronic productive cough. Imaging revealed mild bronchiectasis, and she was treated with chest physiotherapy and nebulized bronchodilators. Over time, her symptoms worsened, with intermittent hemoptysis and progressive weight loss, but she did not seek medical care due to fear of malignancy. Seven years after symptom onset, she was hospitalized for severe hemoptysis. Chest CT revealed bilateral apical cavitary lesions and a tree-in-bud pattern. Initial bronchoalveolar lavage (BAL) cultures were negative, but a positive PPD prompted empiric anti-tuberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide. Subsequent cultures grew MAC, and therapy was modified to azithromycin, rifampin, and ethambutol. Unfortunately, she developed significant gastrointestinal intolerance to multiple macrolides, leading to treatment discontinuation and loss to follow-up. Four years later, she presented with massive hemoptysis, requiring bronchial artery embolization. Over the following 14 years, she received multiple antibiotic regimens, including macrolides, ethambutol, rifamycins, fluoroquinolones, and beta-lactam, but was unable to tolerate long-term therapy due to gastrointestinal side effects and anorexia. Serial imaging demonstrated progressive multilobar bronchiectasis, apical scarring, and bullous changes. In the past five years, she has required over 20 hospitalizations annually for complications including respiratory failure, pneumonia, and failure to thrive. She was also developed severe depression, attributed to her declining quality of life. Currently, she is entirely dependent for daily activities, requires continuous oxygen, and is severely malnourished (BMI 13). Ongoing goals-of-care discussions led to palliative care involvement, and she has since transitioned to home hospice. Discussion This case illustrates the long-term course of MAC infection complicated by treatment intolerance, emphasizing not only the progressive radiographic and clinical deterioration but also the profound emotional toll of repeated treatment failures. For clinicians, it serves as a reminder to recognize and address the significant physical and psychological challenges faced by patients living with this chronic disease. Conclusion Better care coordination is vital to help patients with MAC disease remain adherent. A multidisciplinary approach addressing side effects, mental health, and nutrition can improve outcomes. This abstract is funded by: None
Cordero et al. (Fri,) studied this question.
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