NODULAR BRONCHIECTASIS WITH POSITIVE RESULTS FOR SERUM ANTIBODY TO MYCOBACTERIUM AVIUM COMPLEX, WITHOUT AN EARLY DEFINITE DIAGNOSIS OF PULMONARY MYCOBACTERIUM-AVIUM-COMPLEX DISEASE

sis: blood pressure 99/69 mmHg, heart rate 130 beats/min, and respiratory rates 25 breaths/min. Physical examination revealed holo-crackle on auscultation. Computed tomography revealed lobar pneumonia and multiple infiltration particularly in lower lobes. Ampicillin/sulbactam (ABPC/ SBT) was started on the diagnosis of aspiration pneumonia immediately. However, in the following day, both sputum and two sets of blood culture confirmed Gram-negative coccus, and revealed that organism as K. pneumoniae. Colonies on sheep blood agar illustrated the hypermucoviscous and a string test showed over 5 mm in length, consistent with hvKP. Genetic analysis identified this strain as K2 serotype and having rmpA gene. ABPC/SBT was switched to ceftriaxone and the patient was recovered promptly without recurrence. Results: Although previous investigations reported the emergence of hospital-acquired or ventilator-associated pneumonia caused by hvKP, there was only one report on community-acquired pneumonia due to hvKP in China. Difference between this previous case and the present case are summarized in Table 1, and characteristics of those strains are completely different. Conclusion: We presented the first identified case of communityacquired pneumonia due to serotype K2 hvKP. Although only a small number of pneumonia caused by hvKP has been reported, clinicians need to be aware of the emerging of this strain, as it has many virulence factors in addition to hypermucoviscous phenotype.