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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