Reactions 1704, p108 - 2 Jun 2018
Acquired resistance to antimicrobials: case report
A 39-year-old woman developed acquired resistance
following treatment with clarithromycin, ethambutol and
rifampicin for pulmonary Mycobacterium heckeshornense (M.
heckeshornense) infection [routes and time to reaction onset
The woman was hospitalised for further examinations
following an abnormal chest radiograph, in 2012. She was
initiated on antimicrobial therapy with rifampicin 450 mg/day
and ethambutol 750 mg/day with concurrent administration of
isoniazid and pyrazinamide due to suspected tuberculosis.
Nucleotide sequencing was consistent with M.
heckeshornense, which led to a diagnosis of Pulmonary M.
heckeshornense infection. Antimicrobial susceptibility tests
demonstrated susceptibility to rifampicin, ethambutol and
clarithromycin. Therefore, the antimicrobial therapy was
switched to rifampicin 450 mg/day, ethambutol 750 mg/day
and clarithromycin 800 mg/day. Subsequently, radiographic
findings showed transient improvement for about two years.
Thereafter, the nodule with a cavity and surrounding
infiltrative shadow gradually worsened, which showed that the
strain became resistant to the rifampicin, ethambutol and
The woman was hospitalised and underwent right upper
lobectomy by video-assisted thoracoscopic surgery two years
after the first admission, in 2014. She also completed a
12-month course of rifampicin, ethambutol and clarithromycin
after lobectomy, which did not show relapse during the follow-
up, and sputum culture was negative for mycobacterium
throughout the clinical course.
Author comment: "Although her radiographic findings
transiently improved, the nodule with a cavity and
surrounding infiltrative shadow gradually worsened, which
indicated that the strain had become resistant to the
Kurosaki F, et al. Pulmonary Mycobacterium heckeshornense infection in a healthy
woman. Journal of Infection and Chemotherapy 24: 483-486, No. 6, Jun 2018.
Available from: URL: http://doi.org/10.1016/j.jiac.2018.01.006 -
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved