A Rare Case of Symptomatic Pulmonary Infection Caused by Mycobacterium paraffinicum

<i>Mycobacterium paraffinicum</i> <i>(M. paraffinicum)</i> is a non-tuberculous mycobacterium (NTM) shown to be a human pathogen in recent years. Here, we present a rare case of pulmonary infection caused by <i>M. paraffinicum</i> in a 69-year-old female patient who presented with symptoms, initially thought to be from a chronic obstructive pulmonary disease (COPD) exacerbation. From our literature review, this is a case of <i>M. paraffinicum</i> presenting as a human pathogen. The patient's medical history included COPD, obstructive sleep apnea (OSA), and obesity. Her medical management included inhaled corticosteroid (ICS)/ long-acting beta-agonist (LABA), long-acting muscarinic antagonist (LAMA), and nocturnal continuous positive airway pressure (CPAP) device. For her acute worsening of symptoms, she was treated with oral ciprofloxacin and prednisone for possible COPD exacerbation from presumed pneumonia. However, she showed no improvement in her pulmonary symptoms. Follow-up computed tomography (CT) imaging of the chest showed new scattered "Tree in Bud" opacities. Sputum studies and acid-fast bacilli (AFB) cultures revealed the growth of <i>M. paraffinicum.</i> She was treated with a combination of oral clarithromycin, moxifloxacin, and rifabutin. This case highlights the importance of keeping atypical mycobacteria, such as NTM, as a cause of pulmonary infection in the differential diagnosis, particularly in patients with chronic pulmonary conditions who present with persistent and/or unexplained respiratory symptoms. Early identification is crucial for appropriate treatment to improve patient outcomes.