The Korean Journal of Medicine

  • 제83권2호
  • /
  • Pages.243-248
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  • 2012
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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쇼그렌 증후군 환자에서 발생한 Mycobacterium Massiliense에 의한 재발성 폐렴 1예

A Case of Mycobacterium Massiliense Infection Presenting as Recurrent Pneumonia in Sjogren's Syndrome

  • 서지영 (왈레스 기념 침례병원 내과) ;
  • 이병희 (왈레스 기념 침례병원 내과) ;
  • 이장원 (왈레스 기념 침례병원 내과) ;
  • 이명희 (왈레스 기념 침례병원 내과) ;
  • 오숙경 (왈레스 기념 침례병원 내과) ;
  • 조현명 (왈레스 기념 침례병원 내과) ;
  • 이충원 (왈레스 기념 침례병원 내과)
  • Seo, Ji-Young (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Lee, Byung-Hee (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Lee, Jang-Won (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Lee, Myeong-Hee (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • O, Suk-Gyeong (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Cho, Hyun-Myung (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Lee, Chung-Won (Department of Internal Medicine, Wallace Memorial Baptist Hospital)
  • 발행 : 2012.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

최근 NTM에 대한 인식이 높아지면서 NTM의 분리율 및 NTM에 의한 질환이 증가하고 있다[1,4,7]. M. massiliense는 PCR-RFLP이라는 새로운 진단법으로 최근에 M. abscessus에서 분리되어 새롭게 분류된 균으로[1,4,5] 감염 경로 및 임상양상, 치료 지침에 대해서는 정확히 알려진 바가 없다. 국내에는 지금까지 임상 치료와 관련하여 총 2예의 증례 보고가 있었으나[6,8] 항생제 치료만으로 호전된 폐렴에 대한 보고는 없었다. 저자들은 일차성 쇼그렌 증후군을 진단받은 37세 여자 환자가 3년간 재발성 폐렴이 반복되던 중 M. massiliense가 동정된 후 적절한 항생제 치료만으로 호전된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Mycobacterium massiliense is an emerging pathogen that is increasingly reported as a causative agent occurring during medical procedures, at surgical sites, and intramuscularly [1]. Although previously classified as part of M. abscessus, M. massiliense has recently been identified as a new species of rapidly growing nontuberculous mycobacteria [1,3] via a comparative sequence analysis of rpoB and hsp65 [3,5]. However, the clinical manifestations of M. massiliense have not been well characterized. We report here in a case of recurrent pneumonia for 3 years that improved with antibiotic treatment for M. massiliense in a 37-year-old woman with Sjogren's syndrome. The patient showed a substantial response to treatment with a combination of antimicrobial therapies comprising clarithromycin and amikacin without cefoxitin for 6 months. This is the first report of pulmonary infection of M. massiliense with Sjogren's syndrome in Korea.

키워드

참고문헌

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  2. Management of opportunist mycobacterial infections: Joint Tuberculosis Committee Guidelines 1999: Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000;55:210-218. https://doi.org/10.1136/thorax.55.3.210
  3. Koh WJ, Jeon K, Lee NY, et al. Clinical significance of differentiation of Mycobacterium massiliense from Mycobacterium abscessus. Am J Respir Crit Care Med 2011;183: 405-410. https://doi.org/10.1164/rccm.201003-0395OC
  4. Kim HY, Kook Y, Yun YJ, et al. Proportions of Mycobacterium massiliense and Mycobacterium bolletii strains among Korean Mycobacterium chelonae-Mycobacterium abscessus group isolates. J Clin Microbiol 2008;46:3384-3390. https://doi.org/10.1128/JCM.00319-08
  5. Simmon KE, Pounder JI, Greene JN, et al. Identification of an emerging pathogen, Mycobacterium massiliense, by rpoB sequencing of clinical isolates collected in the United States. J Clin Microbiol 2007;45:1978-1980. https://doi.org/10.1128/JCM.00563-07
  6. Kim HY, Yun YJ, Park CG, et al. Outbreak of Mycobacterium massiliense infection associated with intramuscular injections. J Clin Microbiol 2007;45:3127-3130. https://doi.org/10.1128/JCM.00608-07
  7. Koh WJ, Kwon OJ, Lee KS. Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases: a Korean perspective. J Korean Med Sci 2005;20:913-925. https://doi.org/10.3346/jkms.2005.20.6.913
  8. Yoo JW, Kim YH, Shim TS. A case of Mycobacterium massiliense infection presenting as pneumonia resistant to antibiotics in an immunocompetent host. Tuberc Respir Dis 2010;69:39-42. https://doi.org/10.4046/trd.2010.69.1.39
  9. Bastian S, Veziris N, Roux AL, et al. Assessment of clarithromycin susceptibility in strains belonging to the Mycobacterium abscessus group by erm (41) and rrl sequencing. Antimicrob Agents Chemother 2011;55:775-781. https://doi.org/10.1128/AAC.00861-10
  10. Kim JM, Kim KH, Lee SM, et al. Drug susceptibility and clinical significance of rapidly growing mycobacteria isolated from patients with non-tuberculous mycobacteriosis. Korean J Clin Microbiol 2007;10:143-149.