SUCCESSFULLY TREATED MULTIDRUG-RESISTANT MYCOBACTERIUM SIMIAE

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Mycobacterium Simiae (M. Simiae) is a slow-growing photochromogenic mycobacterium transmitted by inhalation of aerosols or inoculation. It has been recognized as causative agent pulmonary and disseminated disease. Lack standardized treatment regimen makes treating M.Simiae challenge. Here we present case multi-drug resistant with involvement causing massive hemoptysis requiring coil embolization. CASE PRESENTATION: A 72-year-old female known to have bronchiectasis multiple episodes embolization bronchial artery presents for evaluation. Bronchoscopy cultures confirm M. Simiae. The patient was started empirically on clarithromycin, ethambutol, ciprofloxacin while awaiting drug sensitivities. had 2 more admissions weight loss, loss appetite, night sweats. Drug sensitivities showed resistance fluoroquinolones, macrolides, trimethoprim/sulfamethoxazole, isoniazid, rifampin, rifabutin, linezolid. referred the National Jewish Medical Center clofazimine, bedaquiline, inhaled amikacin. Therapy continued 18 months. no being therapy. negative bronchoscopic resolution associated symptoms. DISCUSSION: Infectious Diseases Society America guidelines recommend clarithromycin-based Simiae, but due limited in-vitro susceptibility little evidence its correlation clinical response, challenging. In our case, bacteria it even difficult treat hence required multidisciplinary team approach determine best option available. Only 9-21% isolated are clinically relevant. rarely affects immunocompetent patients mainly described in immunodeficiency syndromes, pneumoconiosis, bronchiectasis, cystic fibrosis. Very few cases extra-pulmonary including salivary glands, gastrointestinal tract, skin lesions, osteomyelitis, lymphadenitis reported. commonly used includes clarithromycin trimethoprim/sulfamethoxazole moxifloxacin duration ranges from 6 24 should be requested each case. Clofazimine bedaquiline drug-resistant pigmentation most common side effect. CONCLUSIONS: multidrug unclear reported, necessitating further research. available options. REFERENCE #1: Lotfi H, Aryan E, Sankian M, Meshkat Z, Khalifeh Soltani A, Alvandi AH, et al. multidrug-resistant simiae an elderly woman. Respirol Rep [Internet]. 2021 Feb 1 [cited Apr 25];9(3). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848708/ #2: Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro Daley C, Gordin F, An Official ATS/IDSA Statement: Diagnosis, Treatment, Prevention Nontuberculous Mycobacterial Diseases. Am J Respir Crit Care Med. 2007 15;175(4):367–416. #3: Javeri Vélez-Mejía Cadena J. Disseminated infection non-immunosuppressed USA. IDCases. 2018 Jan 8;11:58–60. DISCLOSURES: No relevant relationships Mohammed Ali, source=Web Response Rahul Dadhwal, Jared Head, disclosure file Lauren Howard; Salim Surani,