Abstract Introduction Mycobacterium brisbanense is a non-tuberculous mycobacterium (NTM) first discovered in Australia and can be resistant to many of the first line anti-tuberculosis drugs. Studies have shown that patients with chronic lung diseases such as bronchiectasis, asthma, COPD and ILD/IPF are at increased risk of infection with NTM. We will present a case of M.brisbanese infection in a patient with short telomere syndrome associated IPF and pancytopenia due to bone marrow failure attributed to Dyskeratosis Congenita. Description A 33 year-old-man with a past medical history of chronic pancytopenia, cardiomyopathy, short telomere syndrome with associated IPF, and Dyskeratosis Congenita with possible Coats Plus Syndrome was referred to pulmonary clinic for a right sided pleural effusion. He underwent thoracentesis with studies notable for an exudative neutrophilic predominant effusion that eventually grew M. brisbanense. His other work-up was notable for sputum culture growing staphylococcus aureus and beta hemolytic streptococcus group G for which he was started on a course of amoxicillin-clavulanate. Before he could be seen for follow-up, he was admitted for respiratory symptoms and neutropenic fevers in the setting of Respiratory Syncytial Virus and superimposed pneumonia. He underwent a repeat thoracentesis which showed an exudative neutrophilic predominant effusion with negative cultures. It was presumed that the prior M. brisbanese was a contaminant rather than a true infection. He underwent VATS with drainage of thick gelatinous effusion, decortication and pleurodesis to definitively rule out infection prior to anticipated bone marrow transplant. Two weeks post-procedure he was re-admitted for progressive dyspnea and a large hydropneumothorax requiring tube thoracostomy. Both the pleural tissue and fluid from prior VATs grew M. brisbanense. Given the severity of infection with pulmonary and pleural involvement, he was started on amikacin (later switched to sulfamethoxazole/trimethoprim due to ototoxicity) and continued on imipenem and levofloxacin with plans for at least 12 months of treatment after negative cultures. Unfortunately, he developed worsening acute respiratory distress syndrome requiring intubation and multi-organ failure in the setting of hemorrhagic and septic shock ultimately leading to his death. Discussion M. brisbanense is rare type of NTM infection that has only been reported in a few prior cases. To our knowledge this is the first case describing empyema caused by M. brisbanense. Our patient had short telomere syndrome associated IPF and a rare genetic condition known as Dyskeratosis Congenita.These conditions increased his susceptibility to NTM infection for which he received both surgical intervention and prolonged antimicrobial therapy. This abstract is funded by: None
Zhou et al. (Fri,) studied this question.