Nontuberculous Mycobacterial Pulmonary Disease
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Juzar Ali, MD, FRCP(C), FCCP
Louisiana State University Health Sciences Center–Pulmonary & Wetmore Foundation Mycobacterial Diseases Program Clinics, New Orleans, LA

Question 1 of 7

Questions 1 and 2 are based on the following case:

A 67-year-old man who is a life-long smoker with a past medical history of chronic obstructive pulmonary disease (COPD) and who was successfully treated for pan-sensitive Mycobacterium tuberculosis infection 3 years ago presents to the clinic with cough and shortness of breath. Physical examination reveals a thin man with hyperresonance on lung examination and crackles and egophony in the right upper zone. Chest radiograph reveals an old scar with cystic and bullous disease, right lower zone infiltrate, and a cavity in the right upper lobe (Figure). Prior pulmonary function tests showed severe obstructive airway dysfunction. HIV test is negative. One of 3 submitted sputum smears is positive for acid-fast bacilli (AFB). Nucleic acid amplification test (NAAT) for M. tuberculosis of the AFB-positive smear is positive.

Old scar with cystic and bullous disease

Figure. Chest radiograph.

What is the next best step in the management of this patient?

Defer any treatment for mycobacterial infections and wait for culture and sensitivity results

Repeat the NAAT

Start 4-drug M. tuberculosis treatment with rifampin, isoniazid, ethambutol, and pyrazinamide (RIPE)

Start second-line M. tuberculosis treatment with aminoglycoside, ethionamide, and cycloserine

This quiz is not accredited for CME.

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