Table 1 Timeline of case
Location | Event | Laboratory findings | |
|---|---|---|---|
Month, Year | |||
2016 | Unknown | Diagnosed at OSH with emphysema, pulmonary fibrosis | |
2017 | China | Diagnosed with TB in China, treatment on return managed by NYS DOH | |
2018 | NYP Queens | Started on Nintedanib for pulmonary fibrosis, cavitary lesion first demonstrated on Chest CT | |
May, 2021 | NYP CUMC | Initiated lung transplant evaluation | |
Hospital Day | |||
− 22 | NYP Queens | Initial complaint of fever, chills and right upper chest pain | |
− 19 | Admitted for presumed COPD exacerbation | ||
− 18 | Respiratory culture positive for H. parainfluenzae | ||
− 6 | Completes 12 day course of CTX with symptomatic improvement | ||
1 (Sept 2021) | NYP CUMC | Transferred for lung transplant evaluation with ongoing elevated O2 requirement | |
8 | NYP CUMC MICU | Transferred to ICU with increased SOB | |
9 | Placed on VA-ECMO, initial AFB culture collected (tracheal aspirate) | ||
10 | BAL AFB smear negative | ||
14 | 2nd BAL AFB smear positive, MTB/Rif NAAT negative. 1st BAL sample liquid culture flags positive for AFB (4-days growth) | ||
16 | OR | Double lung transplant performed, discharged to CTICU, started on empiric NTM therapy (azithro, mero and amikacin) | |
22 | NYP CUMC CTICU | Therapy changed to azithromycin, ethambutol and amikacin | Identification of M. kumamotonensis by MALDI-TOF from initial AFB specimen (collected HD 9), |
30 | ID of initial BAL specimen confirmed by sequencing (hsp65) | ||
32 | Collection date of first specimen for AFB culture resulting as negative | ||
87 | NYP CUMC Outpatient | Antimicrobial susceptibilities returned, amikacin changed to rifabutin | |
180 | Concludes therapy with all AFB monitoring negative | ||