Non-tuberculous Mycobacterial Lung Disease Presenting as a Solitary Pulmonary Nodule

We report a case of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule (SPN). A 35-year-old male was admitted due to a SPN in the right upper lobe which was detected on the chest radiography being examed due to recurrent cough for 1 year. The computed tomography (CT) revealed a spiculated nodule containing air-bronchogram, which was suspicious of malignancy. We performed transbronchial biopsy and the pathology showed granulomatous inflammation with caseous necrosis. Under the presumptive diagnosis of pulmonary tuberculosis, we started anti-tuberculous medication including isoniazid, rifampin, ethambutol, and pyrazinamide. In one month, however, the sputum culture was positive for Mycobacterium intracellulare. The follow-up chest CT showed slight aggravation of the previous lesions. Under the final diagnosis of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule, we changed the regimen to rifampin, ethambutol, and clarithromycin. The follow-up chest CT after the completion of treatment, revealed resolution of the previous lesions.

keywords: Mycobacterium Infections, Atypical, Solitary Pulmonary Nodule, Tuberculosis, Mycobacterium Infections, Atypical, Solitary Pulmonary Nodule, Tuberculosis

Reference

1. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A,Daley C, Gordin F, et al. An official ATS/IDSA statement:diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007;175:367-416.

2. Koh WJ, Kwon OJ, Lee KS. Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases:a Korean perspective. J Korean Med Sci 2005;20:913-25.

3. Albelda SM, Kern JA, Marinelli DL, Miller WT. Expanding spectrum of pulmonary disease caused by nontuberculous mycobacteria. Radiology 1985;157:289-96.

4. Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1993;14:111-9.

5. Yi CA, Lee KS, Kim EA, Han J, Kim H, Kwon OJ, et al. Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density.Radiology 2004;233:191-9.

6. Lee HS, Oh JY, Lee JH, Yoo CG, Lee CT, Kim YW,et al. Response of pulmonary tuberculomas to anti-tuberculous treatment. Eur Respir J 2004;23:452-5.

7. Tanaka E, Amitani R, Kuze F. Clinical features of the patients with "secondary infection" of Mycobacterium avium complex: radiographic pattern of progressions in the patients with and without underlying pulmonary conditions. Kekkaku 1993;68:57-61.

8. Lynch DA, Simone PM, Fox MA, Bucher BL, Heinig MJ.CT features of pulmonary Mycobacterium avium complex infection. J Comput Assist Tomogr 1995;19:353-60.

9. Gribetz AR, Damsker B, Bottone EJ, Kirschner PA,Teirstein AS. Solitary pulmonary nodules due to nontuberculous mycobacterial infection. Am J Med 1981;70:39-43.

10.

10. Kobashi Y, Yoshida K, Miyashita N, Niki Y, Matsushima T. Pulmonary Mycobacterium avium disease with a solitary pulmonary nodule requiring differentiation from recurrence of pulmonary adenocarcinoma. Intern Med 2004;43:855-60.

11.

11. Hahm CR, Park HY, Jeon K, Um SW, Suh GY, Chung MP, et al. Solitary pulmonary nodules caused by Mycobacterium tuberculosis and Mycobacterium avium complex. Lung 2010;188:25-31.

12.

12. Kwon YS, Koh WJ, Kwon OJ, Lee NY, Han J, Lee KS,et al. Mycobacterium abscessus pulmonary infection presenting as a solitary pulmonary nodule. Intern Med 2006;45:169-71.

13.

13. Ra SW, Lee KH, Jung JY, Kang HS, Park IN, Choi HS,et al. Mycobacterium Kansasii disease presenting as a lung mass and bronchial anthracofibrosis. Tuberc Respir Dis 2006;60:464-8.

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Article Contents

Vol.69 No.1

Non-tuberculous Mycobacterial Lung Disease Presenting as a Solitary Pulmonary Nodule

Abstract

Reference

Tuberculosis & Respiratory Diseases