Nontuberculous Mycobacterial Pulmonary Disease Secondary to Mycobacterium Szulgai

Mycobacterium szulgai was first defined in 1972 as a non-pathogenic mycobacterium. It is a rarely seen nontuberculous mycobacterium (NTM or mycobacteria other than tuberculosis (MOTT)) and evidence of disease usually accompanies its isolation from clinical specimens [1]. The nontuberculous mycobacteria are accounted for significant morbidity in the immunocompetent and immunocompromised host. Mycobacterium szulgai is a slow growing mycobacterium which is rare in nature and humans. It has been isolated from environmental sources such as aquariums, swimming pools, and tropical fish. Therefore, Mycobacterium szulgai disease has to be distinguished from pseudoinfection because of contamination of samples in the laboratory. A few cases have been reported since Mycobacterium szulgai was defined. Several of these cases were the patients with acquired immunodeficiency syndrome (AIDS) [2,3]. Three-drug therapy which is used in vitro susceptibilities as a guide for 12 to 18 months increases the probability for success [4]. Although it involves lungs most commonly, organ involvement and disseminated disease may rarely occur. Herein, we present a case of M. szulgai pulmonary infection developed 24 years after an episode of pulmonary tuberculosis with a discussion of the difficulty for an accurate diagnosis and a review of the relevant literature.