To clarify the clinical features of pleural involvement in nontuberculous Mycobacteria (NTM) infection.
We retrospectively reviewed the medical records of NTM cases with pleural involvement who were admitted to our hospital from April 1994 to March 2004. The diversity of pleural involvement, the underlying disorders, the causative pathogens, the treatments and the prognosis were analyzed.
Eight patients (6 males and 2 females) were enrolled in the study. The mean age was 66.8 years old. Four had pleuritis associated with pneumothorax, two had pleuritis without pneumothorax and the other two had pyothorax associated with bronchopleural fistula. On the review of the chest radiographies, cavitary lesions were found in all pneumothorax patients. The rupture of the cavity was confirmed in three pneumothorax cases by chest CT. As the co-morbit conditions, all the patients were non-HIV, but three had underlying disorders: one patient was under steroid therapy for rapidly progressive glomerulonephritis, the other was after was after total gastrectomy, and the last one was receiving warfarin for chronic pulmonary thromboembolism. As causative pathogens, M. avium was isolated from four cases, M. intracellulare from two, M. kansasii and M. xenopi from each one, respectively. Chest drainage was required in six cases and surgery was performed in five. Two cases of pleuritis alone caused by M. avium or M. kansasii were medically treated without chest drainage and had good clinical courses. The prognosis was relatively good and all the patients survived except for one who was complicated with respiratory failure and undergone mechanical ventilation.
Pleuritis was the most common form of pleural involvement of NTM infection, and M. avium was the most common pathogen. Cavitary lesions were found in all the patients who were associated with pneumothorax, suggesting the responsibility of such cavitary lesions in the pathogenesis of pneumothorax.
Early surgical intervention is essential for successful treatment for NTM infection complicated with pneumothorax.
M. Kawabata, None.