Mycobacterium goodii pulmonary disease in an immunocompetent patient: A case report and literature review.

Mycobacterium goodii is a rapidly growing non-tuberculosis mycobacterium, which is known to cause skin, bone and soft tissue infections, but there are a few reports of respiratory infections due to M. goodii. A 67-year-old man had suffered from productive cough, shortness of breath and weight loss for 6 months. He had a history of total gastrectomy for gastric ulcer perforation. Computed tomography (CT) showed dense consolidation in the right lower lobe and nodular lesions in both lungs. Transbronchial cryobiopsy was performed on a lesion in the right lower lobe and granulomatous lesions were observed pathologically. Because M. goodii was identified from two sputum samples using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), we made a diagnosis of M. goodii pulmonary disease. To confirm the diagnosis, whole genome sequencing analysis was performed, which showed average nucleotide identity of 99.18 %. The patient was responded well to the initial therapy with amikacin, imipenem/cilastatin, doxycycline, sulfamethoxazole/trimethoprim, and clarithromycin, followed by 18 months of ambulatory treatment with doxycycline, sulfamethoxazole/trimethoprim, clarithromycin, and sitafloxacin. The sputum culture remained negative and CT findings also significantly improved 6 months after the introduction of treatment. In this case, the development of M. goodii pulmonary disease is might be associated with the history of gastrectomy. For identifying the pathogen, MALDI-TOF MS and whole genome sequencing analysis were useful and the intensive initial treatment in accordance with the drug susceptibility testing was successful.