CRA83 THE HIDDEN INVADER: ATYPICAL MYCOBACTERIUM FORTUITUM PULMONARY INFECTION IN PEOPLE LIVING WITH HIV

Deanna Nadia Zulkifli Supramaniam, Alif Adlan Mohd Thabit, Anuradha P.Radakrishnan, Nurul Izyan Ghazali, Jen Lye Wan, Noor Izyani Zakaria, Shivaanand Letcheminan

Hospital Selayang, Batu Caves, Malaysia

Introduction
Non-tuberculous mycobacteria (NTM) are opportunistic pathogens of increasing relevance in individuals with HIV. Unlike Mycobacterium tuberculosis, NTM are environmental organisms capable of causing pulmonary, lymphatic, cutaneous, and disseminated infections.

Objective
To elucidate the diagnostic and therapeutic challenges of NTM infections in HIV-positive individuals, especially those with post TB bronchiectasis. Diagnosis requires a comprehensive assessment integrating clinical, radiological, and microbiological data but is often complicated by overlapping features with tuberculosis. NTM infections often present with nonspecific symptoms such as fever, anemia, and weight loss, and require prolonged, species-specific antibiotic therapy.

Methodology
This clinical scenario involves a 54-year-old woman with stable retroviral disease, presented with chronic anemia and constitutional symptoms against a background of post TB bronchiectasis. Sputum cultures yield Mycobacterium fortuitum (single sample), with radiological findings of cystic bronchiectasis, soft infiltrates, and centrilobular nodules without evidence of fungal ball, complementing 2 bronchoscopies findings eliminates the possibility of Mycobacterium tuberculosis or fungal infection. Targeted treatment of NTM was initiated.

Results
The patient showed marked clinical improvement, including weight gain, and radiological clearance of cystic bronchiectasis, infiltrates, and centrilobular nodules. Initial treatment comprised two months of IV amikacin, levofloxacin, and oral linezolid, followed by oral levofloxacin and doxycycline for prophylaxis, with a total treatment duration of at least 12 months post-sputum culture clearance.

Conclusion
This case highlights the need to consider NTM infection in HIV-positive patients with persistent weight loss and anemia, with evidence supported by radiological findings and microbiological confirmation. Effective management requires timely, integrated clinical, radiological, and microbiological evaluation. Treatment involves prolonged multidrug therapy, with early intervention being key to improving outcomes.