Tuberc Respir Dis.  2010 Jul;69(1):43-47.

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

• Kim SY
• Lee KJ
• Lee SH
• Lee SK
• Park BH
• Jung JY
• Son JY
• Yoon YW
• Shim HS
• Kang YA
• Park MS
• Kim YS
• Chang J
• Kim SK
• Moon JW

Abstract

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.

Keyword

Mycobacterium Infections, Atypical; Solitary Pulmonary Nodule; Tuberculosis

MeSH Terms

Adult
Biopsy
Clarithromycin
Cough
Ethambutol
Follow-Up Studies
Humans
Inflammation
Isoniazid
Lung
Lung Diseases
Male
Mycobacterium avium Complex
Mycobacterium Infections, Nontuberculous
Necrosis
Pyrazinamide
Rifampin
Solitary Pulmonary Nodule
Sputum
Thorax
Tuberculosis
Tuberculosis, Pulmonary
Clarithromycin
Ethambutol
Isoniazid
Pyrazinamide
Rifampin

Figure

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  Figure 1 The initial chest X-ray shows a nodular opacity in the right upper lung field.

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  Figure 2 The initial chest CT shows a spiculated nodule with airbronchogram in the right upper lobe.

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  Figure 3 The histologic finding of the transbronchial biopsy specimen shows chronic granulomatous inflammation with caseous necrosis (H&E stain, ×100).

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  Figure 4 The chest CT reveals multiple newly-developed centrilobular nodules after the completion of six-month anti-tuberculous chemotherapy.

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  Figure 5 The follow-up chest CT after the completion of anti-Mycobacterium intracellulare chemotherapy shows the resolution of previous nodular lesions.

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