BACKGROUND: Refractory Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD) is often complicated by anorexia, weight loss, and cachexia. This report describes 2 older adult patients with anorexia and cachexia following refractory MAC-PD given acupuncture treatment to improve appetite and food intake.

CASE REPORT: Case 1 was a man in his 70s with cavitary nodular bronchiectatic MAC-PD diagnosed 7 years earlier based on the 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) criteria. His chest radiographic lesions had progressively worsened, with persistent smear positivity despite multidrug chemotherapy. He developed complete anorexia and eating-related dyspnea; his body weight decreased to 35.4 kg (body mass index [BMI] 11.8 kg/m²). Case 2 was a woman in her 60s who was diagnosed with nodular bronchiectatic MAC-PD with cavities, which developed into a giant cavity, 4 years earlier. She developed severe anorexia and postprandial dyspnea, and her body weight was 31.0 kg (BMI 13.2 kg/m²). Both patients received manual acupuncture at CV12, ST36, LU9, and individualized points 3 times weekly for 3 weeks. Appetite on a 100-mm visual analog scale, energy intake, body weight, and serum albumin improved in both patients. Sputum acid-fast bacillus (AFB) smear status and radiographic findings were unchanged. No adverse events occurred.

CONCLUSIONS: Nine acupuncture sessions over 3 weeks improved appetite, dietary intake, and nutritional indices in 2 cachectic patients with refractory MAC-PD without altering bacteriological or radiological disease activity. Acupuncture merits consideration as adjunctive care for anorexia in this setting. Controlled studies are needed.

Keywords: Acupuncture, Anorexia, Cachexia, Mycobacterium avium-intracellulare Infection, Case Reports