Patient Is Left On Permanent Oxygen Following Delayed Infection Diagnosis

Case Overview

The patient went back to her pulmonologist for a followup appointment after completing the medication treatment and was told by her pulmonologist that she was recovered. However, the patient continued to be symptomatic and expressed concern about her symptoms. The pulmonologist assured her that she was fine. Within the month, the patient began feeling weaker and experienced difficulty walking and sleeping. The patient then began coughing up blood and losing weight. She returned to the pulmonologist, who decided to do a lung bacterial culture. The culture came back positive for mycobacterium avium complex (MAC). He was referred to an infectious disease physician and treatment for the MAC commenced. In spite of multiple treatments, the patient ultimately required oxygen full time.

Questions to the Pulmonology expert and their responses

Please describe your experience diagnosing and treating MAC?

I have treated many cases of MAC and have several patients under my clinical care currently that are on active MAC regimens. I am currently a co-investigator on a clinical trial testing a nebulized antibiotic for MAC at my university.

What sort of symptoms would make you consider MAC?

The classic symptoms of pulmonary MAC infection are cough, weight loss, fatigue, and intermittent low-grade fever.

What is the standard work up and diagnosis criteria for MAC?

The standard workup includes chest CT and multiple sputum samples for AFB smear and culture. Alternatively, one bronchoscopic specimen can be used if the patient is unable to produce sputum. Classic cases of pulmonary MAC involve nodular and bronchiectactic lung disease, often progressing to more cystic and cavitary disease. The presence of typical lung changes with repeated isolation of MAC from sputum samples is classic.

About the expert

This board certified expert has over 20 years of clinical experience. He earned his BS in biochemistry and his MD from Louisiana State University. This expert completed his residency in internal medicine at the Vanderbilt University Medical Center and a fellowship in pulmonary and critical care medicine at the Louisiana State University Health Science Center. This expert is a member of numerous professional organizations, including the Society for Critical Care Medicine and the Research Society on Alcoholism. He previously served as an assistant professor of pulmonary and critical care medicine at the Louisiana State University Health Sciences Center. This expert currently serves as an professsor of pulmonary and critical care medicine at a major university in Louisiana.

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Specialties:

Pulmonology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.