BRONCHOPULMONARY INFECTION WITH MYCOBACTERIUM MALMOENSE PRESENTING ASA BRONCHOESOPHAGEAL FISTULA

We report a bronchopulmonary infection with Mycobacterium malmoense in a patient with severe immunosuppression due to insulin-dependent diab etes mellitus, humoral immunodeficiency after thymoma (Good's syndrome ) and prolonged immunosuppressive treatment after myasthenic crisis. I t presented as non-resolving pneumonia of the left lower lobe. Broncho scopically, a bronchoesophageal fistula was detected. Numerous acid-fa st organisms were found in the sputum specimen and in the bronchial bi opsy around the fistula. M. malmoense was isolated from sputum, bronch oalveolar lavage and bronchial biopsy. Whereas conventional in vitro s usceptibility testing revealed susceptibility only to ethambutol, mult i-drug susceptibility testing confirmed susceptibility to rifampicin, ethambutol, clarithromycin and prothionamide. The clinical outcome aft er 12 months of therapy resulted in a stable remission and considerabl e suppression of the mycobacterial load, but not in complete eradicati on.