Case Report
An 85-year-old woman with COPD, rheumatoid arthritis,
hypertension, and frail performance status in the 2 weeks
prior to admission presented with increasing dyspnea and
cough. She had never smoked. For 10 years she had been
observed by a pulmonologist for COPD and treated with
inhaled corticosteroid (budesonide) and bronchodilator
(formoterol). Her lung-function tests showed moderate obstructive
limitation: FEV1 55% of predicted and FEV1/
FVC 63%. Previous chest radiograph and computed tomogram
were both compatible with fibrotic changes of old
tuberculosis. Mycobacterium kansasii had been detected in
2 of 3 sputum samples 2 years earlier, but she was not
treated for that infection because there was no clinical or
radiologic evidence of non-tuberculous mycobacteria disease.
Bacterial susceptibility testing found the M. kansasii
sensitive to rifampicine.
She had been also observed by a rheumatologist for
rheumatoid arthritis, and was initially treated with methotrexate
(7.5 mg weekly), but had taken only 2 doses
before stopping, 8 years ago, for unknown reasons. No
rheumatoid arthritis activity was detected in the 6 years
before admission. She had not used the immunosuppres-