一个72岁的男人,健康,吸烟者,长期咳嗽,被转诊到我们医院,他的胸部X光检查(CXR)显示右上叶有空腔病变。直接痰涂片,但不是在固体培养基中培养,抗酸杆菌(AFB)阳性,无结核DNA。初步诊断为进展缓慢的非结核感染,CXR显示病情每天都在恶化。四年后,使用商业化的分枝杆菌生长指示管系统在液体培养基中成功培养了AFB的菌落,并通过基质辅助激光解吸电离飞行时间质谱鉴定了该物种。患者对利福平三联疗法反应良好,乙胺丁醇,还有克拉霉素,在接下来的6个月中,痰培养保持阴性,X线照片显示略有改善。
A 72-year-old man, healthy, smoker, with long-standing cough, was referred to our hospital and his chest X-ray (CXR) revealed a cavity lesion in the right upper lobe. Direct sputum smears, but not culture in solid medium, were positive for acid-fast bacilli (AFB) without tuberculosis DNA. The preliminary diagnosis was of a non-tuberculosis infection that progressed slowly, and the CXR showed the condition to worsen daily. Four years later, a commercialized mycobacteria growth indicator tube system was used to culture the colonies of AFB successfully in liquid medium, and the species Mycobacterium heckeshornense was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The patient responded well to triple therapy with rifampicin, ethambutol, and clarithromycin, the sputum cultures remained negative and the roentgenogram showed minor improvement over the following 6 months.