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It is susceptible to multiple antibiotics both in vitro and in clinical practice, so that any combination of susceptible drugs is effective. However, we encountered a case of infection due to fluoroquinolone-resistant <jats:italic>M. fortuitum<\/jats:italic>. In this study, we report the case and describe the mechanism of resistance.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>A 65-year-old man with a history of total gastrectomy and immunosuppressant treatment for rheumatoid arthritis developed a recurrence of pulmonary infection caused by <jats:italic>M. fortuitum<\/jats:italic>. He was treated with clarithromycin and levofloxacin as a first-line treatment, based on the favorable susceptibility at that time. After recurrence, a high minimum inhibitory concentration to fluoroquinolones was detected. DNA sequencing of the pathogen showed the substitution of serine for tryptophan at residue 83 in the <jats:italic>gyrA<\/jats:italic> gene. He was successfully treated with a combination of other antibiotics.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This is the first report on the treatment of fluoroquinolone-resistant <jats:italic>M. fortuitum<\/jats:italic> and investigation of the mechanism of resistance. We suggest that the susceptibility test remains effective for determining the next line of treatment after a pathogen has acquired resistance, and resistance to fluoroquinolones in <jats:italic>M. fortuitum<\/jats:italic> can be attributed to a single change of amino acid.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12879-020-05596-1","type":"journal-article","created":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T22:45:47Z","timestamp":1605825947000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pulmonary infection due to fluoroquinolone-resistant Mycolicibacterium fortuitum: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Kana","family":"Kurokawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0962-5731","authenticated-orcid":false,"given":"Norihiro","family":"Harada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Sasano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhi","family":"Takagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satomi","family":"Takei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayako","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kikuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhisa","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"issue":"2","key":"5596_CR1","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1111\/j.1365-2672.2009.04161.x","volume":"107","author":"JO Falkinham 3rd","year":"2009","unstructured":"Falkinham JO 3rd. 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