Tuberc Respir Dis.  2013 Jul;75(1):28-31.

Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient Treated with Methotrexate

• Park JS
• Jung ES
• Choi W
• Park SY
• Rim MY
• Yu I
• Park H
• Lee SM
• Park JW
• Jeong SH
• Lee SP
• Park S

Abstract

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.

Keyword

Nontuberculous Mycobacteria; Tuberculosis, Pulmonary; Methotrexate; Arthiritis, Rheumatoid; Bronchial Diseases

MeSH Terms

Arthritis, Rheumatoid
Bronchial Diseases
Female
Humans
Lung Diseases
Methotrexate
Mycobacterium
Mycobacterium avium Complex
Nontuberculous Mycobacteria
Opportunistic Infections
Tuberculosis, Pulmonary
Methotrexate

Figure

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  Figure 1 Plain radiography (A) and computed tomography (B) of the chest of a 58-year-old woman who was infected with Mycobacterium intracellulare showed multifocal nodular consolidation and ill-defined nodules in both lungs, and this was all more prominent in the mid-lung field of the right lung, without evidence of mediastinal lymphadenopathy.

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  Figure 2 Bronchoscopic photograph of the left main (A) revealed diffuse actively caseating endobronchilal lesions. The bronchial biopsy specimen (B) from the left main bronchi showed granulomatous inflammation with caseating necrosis (H&E stain, ×100).

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