Successful desensitization to clarithromycin and moxifloxacin for the treatment of nontuberculous mycobacteria infection

초록

Introduction: Nontuberculous mycobacteria (NTM) are ubiquitous organisms that are generally found in the environment. The incidence and prevalence of NTM infection are increasing worldwide. NTM infection is associated with impaired quality of life, increased morbidity and mortality, and pose various challenges to the treatment. Although diagnosis of NTM infection does not always require treatment, multidrug therapy based on susceptibility test is necessary when treatment is required. We report a case of successful desensitization of clarithromycin and moxifloxacin in a patient with Mycobacterium massiliense lung disease and with hypersensitivity to both drugs. Case Report: A 47-year-old woman came to the hospital for the evaluation of abnormal findings in chest x-ray. Five years ago, she had been diagnosed with Mycobacterium massiliense infection. But she lost her follow-up 4 months later while observing without any treatment due to a stable NTM lung disease and no symptoms. Recent chest x-ray showed aggravation of lung diseases compared to previous study, and progression of Mycobacterium massiliense lung disease was diagnosed based on chest CT, bronchial washing study and microbiological testing with identification PCR assay. Drug sensitivity test revealed resistance to rifampin and ethambutol, thus treatment started with clarithromycin, moxifloxacin and amikacin. She developed generalized maculopapular eruption and itching 24 days after initial treatment, and clarithromycin and moxifloxacin were stopped. After treatment with oral corticosteroids and anti-histamines, her symptoms improved and graded challenge tests using clarithromycin and moxifloxacin were performed to identify the causative drug. As a result, the patient experienced the same adverse reaction for both clarithromycin and moxifloxacin, respectively. Sequential desensitization to clarithromycin and moxifloxacin was successfully performed, and the patient was able to perform additional treatment