Abstract
Relevance. In recent years, there has been an increase in nontuberculous mycobacteriosis, including cases combined with pulmonary tuberculosis. Diagnosis of co-infection is challenging due to the similarity of clinical and radiological findings, while treatment presents a complex task because of the heterogeneous drug susceptibility of the pathogens. Case Description. We present a case of a 49-year-old female patient with recurrent drug-resistant pulmonary tuberculosis, chronic obstructive pulmonary disease, and severe underweight (Body Mass Index 15.0). Examination using the GenoType® Mycobacterium CM method confirmed co-infection with M. tuberculosis and M. avium complex. The patient was prescribed an individualized chemotherapy regimen including bedaquiline, linezolid, clofazimine, levofloxacin, cycloserine, and clarithromycin. Results. After 8 months of treatment, sputum conversion was achieved (negative sputum smear microscopy and culture), with favorable radiological changes and clinical improvement. Conclusion. This case demonstrates the fundamental possibility of successful treatment of drug-resistant pulmonary tuberculosis and nontuberculous mycobacteriosis co-infection using a combination of reserve anti-tuberculosis drugs and macrolides, despite diagnostic limitations, the complexity of selecting a chemotherapy regimen, and challenges in patient routing for those with co-infection.