CASE DESCRIPTION
A 56-year-old female patient had been on medication for macrolide-resistant pulmonary Mycobacterium avium complex disease, and had persistently had positive sputum cultures. Because the minimal inhibitory concentration (MIC) of amikacin was sensitive at 4μg/ml, She started amikacin liposomal inhalation suspension (ALIS) in combination with rifampicin and ethambutol. Thereafter, the amount of bacteria in the sputum smear gradually decreased, the cough and sputum were under control. However, hoarseness appeared one month after treatment initiation. Fiberoptic laryngoscopy showed redness and swelling of both vocal cords, indicating laryngitis (Figure 1, black arrow). ALIS therapy was discontinued, and hoarseness improved within a few days. After two weeks, the treatment was resumed and administered every other day. There was no recurrence of hoarseness until five weeks after the resumption, at which point laryngitis had healed (Figure 2, white arrow). There was no laryngeal edema consistently.
It has been reported that dysphonia occurs in 46.6% of patients subjected to daily ALIS (1), but can improve with a temporary reduction in ALIS inhalation frequency (2). In the present case, the vocal cord morphologically returned to normal after seven weeks of dose reduction. This report suggests that, in case hoarseness appears, intermittent inhalation could permit healing while continuing treatment.
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