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Case report
Importance of asking a social history: atypical pulmonary infections and occupational hazards
  1. Hiten Patel,
  2. Christopher Skok,
  3. Dana Maxwell and
  4. Selim Sheikh
  1. Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  1. Correspondence to Dr Hiten Patel; hiten.patel{at}osumc.edu

Abstract

Non-tuberculous mycobacteria (NTM) are ubiquitous in the environment, but NTM infection is limited to individuals with risk factors. We present a case of a 62-year-old man who presented with a 1 year history of cough and shortness of breath. History was notable for significant tobacco use and work as a sandblaster without the use of personal protective equipment. His chest X-ray showed bilateral upper lobe cavitary lesions, which were redemonstrated on chest CT. A sputum Gram stain was positive for acid-fast bacilli, but his tuberculosis QuantiFERON was negative. He was started on empiric tuberculosis treatment. Sputum cultures ultimately returned for Mycobacterium avium intracellulare complex, and treatment was narrowed to azithromycin, rifampin and ethambutol. The case highlights risk factors for NTM infection, notably for this patient, occupational exposures that likely lead to the development of pneumoconiosis. Healthcare providers should ask about occupational history and counsel patients about protection from occupational hazards.

  • infections
  • general practice / family medicine
  • TB and other respiratory infections
  • occupational and environmental medicine
  • exposures

https://doi.org/10.1136/bcr-2021-246567

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    Footnotes

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    • Contributors HP, CS, DM, and SS were all involved in the planning, literature review, and creation of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.