Figure 2.

The patient’s clinical course. After he was transferred to our hospital, the prednisolone (PSL) dose was gradually tapered. He was temporarily transferred to the previous hospital until the NTM species were identified (days 53-139). With the identification of M. kansasii, we re-transferred him to our hospital and started treatment with rifampicin (RFP), clarithromycin (CAM), and ethambutol (EB) on day 140. Since his general condition temporarily worsened, we added isoniazid (INH) to the treatment regimen. From day 163, we administered 200 mg/day of intravenous hydrocortisone for 3 days because of suspected adrenal insufficiency, followed by an increase in the oral PSL dose to 20 mg/day to suppress anti-interferon (IFN)-γ autoantibody production. We also added intravenous immunoglobulin for the treatment of disseminated nontuberculous mycobacterial infection (DNTM) on days 160-162. On day 260, the patient was discharged with a successfully tapered PSL dose.