Successful treatment of Mycobacterium abscessus infection with alternate-day half-dose linezolid: A case report and literature review

Abstract

Mycobacterium abscessus (Mab) is a common rapidly growing non-tuberculous Mycobacterium (NTM). On the basis of host immune deficiency (such as positivity for anti-IFN-γ autoantibodies), it can cause a variety of diseases, with pulmonary infection being the most common, followed by skin and soft tissue infections. Currently, the clinical treatment for Mab infections mainly relies on a multi-drug combination regimen centered around macrolides. However,  due to the limited number of drugs active against Mab, along with a long treatment course, a high susceptibility to macrolide-induced resistance, and poor treatment compliance caused by adverse drug reactions, clinical treatment is challenging and it is difficult to achieve satisfactory therapeutic outcomes. This article reports a case of skin and soft tissue infection caused by Mab in a patient with a drug allergy constitution and multiple adverse drug reactions. During the maintenance treatment phase, after repeated adjustments to the anti-infective regimen, a treatment strategy was ultimately adopted: taking half the daily dose of linezolid (600 mg, QD) on odd-numbered days and the regular dose of linezolid (600 mg Q12H) on even-numbered days, which led to successful treatment. Meanwhile, we reviewed relevant literature with the aim of exploring individualized treatment plans for Mab and providing reasonable treatment recommendations for clinicians.