Yonsei Med J.  2010 Jan;51(1):141-144. 10.3349/ymj.2010.51.1.141.

Sequential Bilateral Lung Resection in a Patient with Mycobacterium Abscessus Lung Disease Refractory to Medical Treatment

• Lee SH
• Min JW
• Um SW
• Han SS
• Han SK
• Shim YS
• Yim JJ

• KMID: 1779621
• DOI: http://doi.org/10.3349/ymj.2010.51.1.141

Abstract

Mycobacterium abscessus (M. abscessus) is the second most common nontuberculous mycobacteria (NTM) in South Korea. Nevertheless, the diagnosis and treatment of M. abscessus lung disease can be problematic. Surgical resection has been tried for patients with localized M. abscessus lung disease refractory to medical treatment. Here, we report on a 25-year-old woman with M. abscessus lung disease who had been diagnosed and treated three times for pulmonary tuberculosis. She was initially diagnosed as having M. intracellulare lung disease; however, M. abscessus was isolated after several months of medication. She had multiple bronchiectatic and cavitary lesions bilaterally, and M. abscessus was repeatedly isolated from her sputa despite prolonged treatment with clarithromycin, ethambutol, moxifloxacin, and amikacin. She improved only after sequential bilateral lung resection. Based on the experience with this patient, we suggest that, if medical treatment fails, surgical resection of a diseased lung should be considered even in patients with bilateral lesions.

Keyword

Atypical mycobacteria; surgery; therapeutics

MeSH Terms

Adult
Anti-Bacterial Agents/pharmacology/*therapeutic use
Female
Humans
Lung Diseases/*drug therapy/*microbiology/surgery
Mycobacteria, Atypical/drug effects/*physiology

Figure

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  Fig. 1 High-resolution computed tomography (HRCT) on admission showed the collapse with bronchiectasis of right middle lobe, cavitary lesion of left lower lobe, and multiple branching linear opacity on both lower lobes (A and B). Follow-up HRCT performed one year following the medical treatment revealed minimal improvement (C and D). No newly developed lesion was observed on HRCT taken eight months after bilateral lung resection (E and F).

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