# A Rare Pathogenic Masquerader of Pulmonary Disease: A Case Report

## TL;DR

A 61-year-old COPD patient with a rare Mycobacterium szulgai infection showed clinical improvement after treatment, highlighting challenges in diagnosing and managing rare lung infections.

## Contribution

This case report highlights the diagnostic and therapeutic challenges of rare nontuberculous mycobacterial infections in patients with pre-existing lung disease.

## Key findings

- The patient showed clinical improvement and weight gain following a multi-drug regimen.
- Radiographic abnormalities decreased, though sputum cultures remained positive.
- Mycobacterium szulgai was identified as a rare pathogen in a COPD patient.

## Abstract

This case report details a 61-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) and significant smoking exposure, who presented with progressive anorexia, weight loss, nocturnal sweating, and worsening respiratory symptoms in early 2024. Imaging revealed bi-apical opacities with cavitation, and sputum cultures identified Mycobacterium szulgai, a rare nontuberculous mycobacterium (NTM). The patient was managed with a multi-drug regimen including azithromycin, rifampin, and ethambutol, targeting symptom relief, radiographic stability, and sputum conversion. Early treatment results demonstrated clinical improvement, weight gain, and decreased radiographic abnormalities, although sputum studies remained positive. This case underscores the diagnostic and therapeutic complexities of rare NTM infections in patients with underlying lung disease.