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Chest Infections |

A Case of M. avium Lung Disease Presented as Pleurisy

HyeKyeong Park, MD; Sung Soon Lee, MD
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Pulmonary and Critical Care Medicine, Inje University, Ilsan Paik Hospital, Goyang-shi, Republic of Korea


Chest. 2014;146(4_MeetingAbstracts):153A. doi:10.1378/chest.1994271
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Abstract

SESSION TITLE: Infectious Disease Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Nontuberculous mycobacterial (NTM) infection is rarely accompanied by pleural involvement. We report an rare case of with M. avium pleuritis with pleural effusion.

CASE PRESENTATION: A 50-year-old woman was admitted to hospital because of left chest and flank pain. She had a past TB history in her 20s. Chest X ray film revealed unilateral pleural effusion in the left lung. Chest CT scan showed loculated pleural effusion and irregular subpleural nodule with calcification in the left lung and pulmonary nodule in the right lung. Acid-fast bacilli were detected in sputum, not pleural effusion. Polymerase chain reaction (PCR) test was negative for Mycobacterium tuberculosis (M. tuberculosis) but positive for Mycobacterium avium (M. avium). many colonies of M. avium complex ( MAC) were cultured from sputum for four times. The predominance of lymphocytes among the cells detected in pleural effusion and the pleural effusion adenosine deaminase (ADA) activity was 52.2U/l. NTM was considered as the most probable diagnosis. After we administered three drugs (rifampin, ethambutol and clarithromycin), M. avium culture became negative conversion, pleural effusion in the left lung disappeared. These improvements confirmed the diagnosis of empyema caused by M. avium.

DISCUSSION: Pleuritis is a rare complication associated with nontuberculous mycobacteriosis of the lung and its etiology remains to be clarified. Although it is difficult to diagnose pleuritis with NTM, patients often present with at least 1 of the following signs: the presence of nontuberculous mycobacterium in pleural effusion, a predominance of lymphocytes among the cells detected in pleural effusion, a high adenosine deaminase level, and the disappearance of pleural effusion following treatment. Recognizing these signs may aid the diagnosis of pleuritis with NTM.

CONCLUSIONS: In summary, our case shows that acute pleural effusion should be considered in patients with pulmonary diseases caused by MAC. Physicians should be aware of acute pleural effusion caused by MAC in non-immunocompromised patients.

Reference #1: Intern Med. 2006;45(17):1007-10. Epub 2006 Oct 2.Acute pneumonia and empyema caused by Mycobacterium intracellulare. Park SU1, Koh WJ, Kwon OJ, Park HY, Jun HJ, Joo EJ, Lee NY, Kim TS, Lee KS, Park YK.

Reference #2: Nihon Kokyuki Gakkai Zasshi. 2011 Dec;49(12):885-9. Nontuberculous pulmonary mycobacteriosis complicated by pleuritis. Ichiki H1, Ueda S, Watanabe A, Sato C, Abe M.

Reference #3: Respiration. 2002;69(6):547-9. Mycobacterium avium complex pleuritis. Yanagihara K1, Tomono K, Sawai T, Miyazaki Y, Hirakata Y, Kadota J, Kohno S.

DISCLOSURE: The following authors have nothing to disclose: HyeKyeong Park, Sung Soon Lee

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