Thus, along with the other case reports2,3,4,5, our case indicates that physicians should be aware of the possibility of infection with this rare but emerging organism ifMycobacteriumspecies is not detected with AFB culture or PCR methods from positive AFB smear specimens. cough lasting for 3 months. About 20 years earlier, she had been treated for pulmonary tuberculosis. The patient had experienced chronic coughing for the previous 3 years. A chest X-ray and chest computed tomography (CT) taken 2 years previously revealed centrilobular nodules and bronchiectatic changes (Figure 1). Although AFB cultures yieldedMycobacterium abscessusgrowth on several occasions at that time, she did not undergo treatment forM. abscessusbecause her symptoms were mild and CT did not reveal severe changes. She therefore underwent regular follow-up visits. Although she had been relatively well and her chest X-ray did not show significant changes during the approximately 2-year follow-up, she experienced an aggravation of her symptoms. == Figure 1. == An initial chest computed tomography scan of the studied patient showing bronchiectatic changes with small centrilobular nodules in the lingular division of the left upper lobe, the right middle lobe, the right lower lobe, and the left lower lobe. On physical examination, the patient was alert and in no distress. Her body temperature was 36.3, blood pressure was 106/70 mm Hg, pulse was 72 beats per minute with a regular rhythm, and respiratory rate was 20 breaths per minute. Bronchial breathing Fondaparinux Sodium sounds and inspiratory rhonchi were heard in the bilateral anterior chest. A complete blood count revealed a white blood cell count of 6,500/mm3(64% neutrophils), hemoglobin of 13.7 g/dL, and platelets of 239,000/mm3. Her C-reactive protein concentration was 1.7 mg/dL. Routine chemical laboratory data were all within normal ranges. The patient was negative for antibodies to human immunodeficiency virus. Compared with Rabbit Polyclonal to C-RAF (phospho-Ser301) a scan taken 2 years previously, her chest CT showed an increased amount and extent of multifocal small nodules as well as newly developed consolidation (Figure 2). Multiple specimens were examined for mycobacteria. Although AFB stains were positive in sputum examination using both auramine-rhodamine fluorescent and Ziehl-Neelsen methods, no organism was identified using an ACE detection kit (Seegene, Seoul, Korea) that can detect bothMycobacteriumtuberculosis (MTB) and non-tuberculosis mycobacterium (NTM). == Figure 2. == A chest computed tomography scan performed 2 years later in the studied patient showing an increased extent of the nodules, particularly in the right middle lobe and right lower lobe, Fondaparinux Sodium and newly developed patchy consolidation in the right lower lobe. To identify a source of infection other than MTB or NTM, 16S rRNA polymerase chain reaction (PCR) was performed using primers specific for the 9-806 bp (8FPL: 5′-AGT TTG ATC CTG GCT CAG-3′, 806R: 5′-GGA CTA CCA GGG TAT CTA AT-3′) and 515-1,390 bp (515FPL: 5′-TGC CAG CAG CCG CGG TAA-3′, 13B: 5′-AGG CCC GGG AAC GTA TTC AC-3′) segments according to previously published methods6. Purified PCR products were directly sequenced using the BigDye Terminator v3.1 Cycle Fondaparinux Sodium Sequencing kit (Applied Biosystems, Foster City, CA, USA). According to a search using the Basic Local Alignment Search Tool (BLAST) database (http://www.ncbi.nlm.nih.gov/blast/) and EzTaxon-e (http://eztaxon-e.ezbiocloud.net/), the sequence of this isolate exhibited 100% homology (1,316 of 1 1,316 bp) with that ofS. rugosusATCC BAA-974T and 98.8% homology (1,300 of 1 1,316 bp) with that ofS. rotundusDSM 44985T. In line with the Clinical Laboratory Standard Institute guidelines, the Fondaparinux Sodium organism was identified asS. rugosus7. Drug susceptibility testing forS. rugosusfailed several times due to contamination and inadequate growth. Antibiotic treatment forS. rugosuswas initiated with oral clarithromycin at 1,000 mg/day and moxifloxacin at 400 mg/day for 6 months, intravenous amikacin 15 mg/kg/day for 3 months, and intravenous imipenem/cilastatin 2,250 mg/day for 1 month. The patient’s symptoms improved rapidly after initiation of treatment and culture conversion was seen after 1 month. Treatment was completed after 6 months at which time a CT scan was taken and showed an improvement in lung lesions (Figure 3). The patient has since been on a regular follow-up for 1 year at our hospital without. == Figure 3. == A chest computed tomography (CT) scan after completion of treatment forSegniliparus rugosusinfection showing a decreased extent of the nodules compared with that in the previous CT scan and the disappearance of consolidation. == Discussion == We have here described here a very rare case ofS. rugosusinfection in an immunocompetent patient with non-cystic fibrosis. Only a few studies to date have reportedS. rugosusinfection in patients with cystic fibrosis2,3or simpleS. rugosusisolation from a patient with radiographic features mimicking those of NTM5. To our knowledge, our current report is the first to describe Fondaparinux Sodium a case of infection due toS. rugosusin a non-cystic fibrosis patient that was successfully treated with antibiotics. In our current patient,S. rugosusinfection seemed.