Successful treatment of Mycobacterium abscessus pulmonary disease with limited resection and perioperative chemotherapy containing clofazimine: a case report

We report a case of localized Mycobacterium abscessus complex pulmonary disease with phenotypic inducible macrolide resistance in a previously healthy woman in her 40s. Chest computed tomography (CT) showed a solitary thin-walled cavitary nodule with perilesional centrilobular nodules, confined to the right upper lobe. Bronchial lavage culture grew M. abscessus subsp. abscessus/bolletii . Clarithromycin susceptibility shifted from susceptible on Day 3 to resistant on Day 14. Combination antimicrobial therapy was initiated with imipenem/cilastatin, amikacin, azithromycin, clofazimine, and sitafloxacin. This led to rapid radiologic improvement, and video-assisted thoracoscopic wedge resection was performed 24 days after initiation of antimicrobial therapy. Culture and PCR of the resected specimen were negative for pathogens. The patient completed a 12-month course of antimicrobial therapy and remains recurrence-free at 30 months based on CT follow-up. The only notable side effect of chemotherapy was grade 2 skin hyperpigmentation, which was attributed to clofazimine.