A 58–year–old female presented with progressively worsening shortness of breath over years with rapid worsening over the previous weeks. Her medical history is notable for progressive pulmonary disease secondary to M. kansasii diagnosed 3 years prior. At that time it was recommended that she undergo antimicrobial therapy, however she declined and pursued a “natural” approach. Nevertheless, she never consulted a licensed naturopathic provider. Upon admission, her physical exam was notable for cachexia and bilateral pulmonary rales. Chest radiograph (CXR) demonstrated worsening fibro–nodular densities with cavitary change. Computerized tomography (CT) of the chest revealed similar changes with large areas of cavitation. Multiple sputum cultures grew M. kansasii. She agreed to a 12–month, three–drug regimen consisting of rifampin, isoniazid, and ethambutol. After 1 month of therapy, she developed respiratory failure and was transferred to hospice.
In the modern era, it is uncommon to witness the natural course of certain diseases, especially those with good response to available treatments. We present a case of natural progression of pulmonary M. kansasii infection after the patient chose a “non–traditional” treatment option. Alternative medicine, also known as complementary, integrative, or unconventional medicine (CAM), is functionally defined as interventions neither taught widely in medical schools nor available in many US hospitals. The popularity of CAM is rising, with up to 75% of patients in some series pursuing an alternative approach as part of their health care. While there is an increasing demand for personalized medicine, the rush to embrace new alternative therapies should be approached with caution and only by licensed providers. Although CAM therapies are popular, they have not been subjected to rigorous studies and therefore there are often not evidence–based guidelines. Factors attracting patients to CAM include dissatisfaction with conventional medicine and a holistic orientation to health, illness and treatment, among others. Currently, naturopathic medicine does not offer an option for M. kansasii treatment, whereas the American Thoracic Society and Infectious Disease Society of America consensus guidelines for the treatment of M. kansasii are based on category A, grade II evidence level. When pulmonary M. kansasii disease is left untreated, its mortality can reach 50%, decreasing to 2–11% when appropriate treatment is instituted.
When left to nature, M. kansasii can cause devastating illness. We emphasize the importance of educating and understanding patients’ misconceptions on both conventional and alternative medicine to help optimize their healthcare experience.