Abstract
Mycobacterium avium complex (MAC) pulmonary disease presents significant therapeutic challenges in respiratory medicine. While amikacin liposome inhalation suspension (ALIS) has emerged as a promising option for treatment-refractory cases, some patients continue to show persistence of infection. We report a case of a 64-year-old male with MAC pulmonary disease who demonstrated a remarkable clinical response to sitafloxacin (STFX) after failing both guideline-based therapy and subsequent ALIS treatment. Although ALIS initially achieved temporary culture conversion, the patient experienced disease recurrence. Following the initiation of STFX, the patient showed significant clinical improvement with resolution of hemoptysis within three months, achieving sustained culture conversion, which has persisted for over two years. This case highlights the potential role of STFX as an effective therapeutic option in the management of refractory MAC pulmonary disease, particularly in cases where guideline-based treatments, including ALIS, have failed.