PMC10290463_01
PET/CT and Laryngeal endoscopy findings before and after antibiotic therapy.
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Positron emission tomography/computed tomography (PET/CT), performed in June 2021 to identify the focus of infection, showed 18-fluorodeoxyglucose accumulation with a maximum standardized uptake value of 3.5 in the right nasopharyngeal wall (Figure 1a). Laryngeal endoscopy revealed purulent discharge in the right nasopharynx (Figure 1b). The posterior rhinorrhoea improved, and laryngeal endoscopy performed in February 2022 revealed the absence of purulent discharge in the nasopharynx (Figure 1c). PET/CT performed in May 2022 confirmed the disappearance of the previously observed abnormal accumulation in the right nasopharyngeal wall (Figure 1d).
Whole-genome sequencing of M. abscessus isolates from our patient.
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Whole-genome sequencing of M. abscessus subsp. abscessus constitutively isolated from the patient revealed that all strains belonged to a phylogenetic cluster, ABS-GL4 (Figure 2a). The pairwise SNP distance between these isolates was less than 10 SNPs (Figure 2b). Mutations in the 23S rRNA (rrl) gene conferring macrolide resistance were not detected in these isolates, but they carried the functional erm(41) gene (Figure 2a), which was expected to induce macrolide resistance. In addition, the strains did not harbour the known A1375G substitution in the 16S rRNA (rrs) gene, which confers amikacin resistance (Figure 2a).