Kawamura Ai, Sugawara Hitoshi, Fukuchi Takahiko, Tanaka Akira
Department of Comprehensive Medicine, Division of General Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JPN.
Department of Pathology, Saitama Medical Center, Jichi Medical University, Saitama, JPN.
Cureus. 2021 Oct 22;13(10):e18967. doi: 10.7759/cureus.18967. eCollection 2021 Oct.
The management of macrolide-resistant complex (MAC) disease is challenging. It is extremely rare for non-human immunodeficiency virus (HIV)-infected patients to develop disseminated MAC disease. A 73-year-old non-HIV-infected woman was diagnosed with MAC lung disease (MAC-LD) for 20 years and subsequently chronic necrotizing pulmonary aspergillosis for three years. To avoid drug interaction between rifampicin and voriconazole, MAC-LD was treated with clarithromycin (CLR) alone. The results of the bone biopsy and bone marrow culture conducted for back pain were compatible with CLR-resistant MAC vertebral osteomyelitis. The clinical management of CLR-resistant disseminated MAC disease consisting of lung and spinal lesions with no established treatment and a poor prognosis is challenging. In this case, the patient was treated with multidrug antibiotic therapy, including CLR, ethambutol, rifampicin, amikacin, and moxifloxacin. The results show the effectiveness of multidrug antibiotic therapy in treating CLR-resistant disseminated MAC disease.
大环内酯类耐药复合群（MAC）疾病的管理具有挑战性。未感染人类免疫缺陷病毒（HIV）的患者发生播散性MAC疾病极为罕见。一名73岁未感染HIV的女性被诊断为MAC肺病（MAC-LD）20年，随后又被诊断为慢性坏死性肺曲霉病3年。为避免利福平和伏立康唑之间的药物相互作用，MAC-LD仅用克拉霉素（CLR）治疗。针对背痛进行的骨活检和骨髓培养结果与耐CLR的MAC椎体骨髓炎相符。由肺部和脊柱病变组成的耐CLR播散性MAC疾病，由于没有既定的治疗方法且预后较差，其临床管理具有挑战性。在该病例中，患者接受了包括CLR、乙胺丁醇、利福平、阿米卡星和莫西沙星在内的多药联合抗生素治疗。结果显示多药联合抗生素治疗对耐CLR播散性MAC疾病有效。
