A CASE OF NONTUBERCULOUS MYCOBACTERIA ASSOCIATED WITH BRONCHIAL ATRESIA

Abstract

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: This case report describes an extremely rare condition of nontuberculous mycobacteria associated with bronchial atresia. To the best of our knowledge, there has been only one case report which described this condition. CASE PRESENTATION: A 35-year-old woman presented to the previous hospital for right back pain and dry cough that persisted for two days. Chest radiograph showed a mass-like shadow in the right lower lung field. Initially, she was diagnosed with pneumonia and antibiotic treatment (clavulanate/amoxicillin and azithromycin) was started. On the eighth day of antibiotic treatment, the abnormal shadow in the right lower lung field on chest radiograph enlarged and she was referred to our hospital for a detailed examination and treatment. On admission, her body temperature was 37.6℃, blood pressure was 145/87mmHg, and other vital signs were normal. Laboratory test values, including serum interleukin-2 receptor, antinuclear antibody, PR3-ANCA and MPO-ANCA, were within normal limits. Contrast-enhanced chest computed tomography (CT) revealed irregular consolidation in the lower lobe of the right lung with internal calcification, emphysematous changes around the lesion, a Y-Shaped opacity considered to be an obstructed bronchus. Fiberoptic bronchoscopy showed no abnormal findings. From these findings, some infectious disease associated with congenital lung malformation was suspected. Her slight fever persisted and the lesion in the right lower lobe did not improve despite antibiotic treatment. Therefore, she underwent right lower lobectomy for the definitive diagnosis and treatment. Histological examination of the surgical specimen revealed multiple granulomas with multinucleated giant cells, necrosis, and psammoma bodies. BCG stain and Auramine O fluorescence microscopy stain were positive. Finally, PCR of the surgical specimen revealed positive results for Mycobacterium avium. From these findings, the patient was diagnosed with nontuberculous mycobacteria associated with bronchial atresia, and her condition was stable after the surgery without any treatment. DISCUSSION: Nontuberculous mycobacteria complicated with bronchial atresia is an extremely rare condition. To the best our knowledge, there is only one case report describing this condition in the English literature (1). For making a definitive diagnosis, necrotizing sarcoid granulomatosis (NSG) was a very important differential disease. NSG is also an extremely rare disease characterized by pulmonary infiltrations with pathological findings, consisting of granulomas with variable extent of necrosis and vasculitis (2). In our patient, BCG stain and PCR identified Mycobacterium avium, and NSG was excluded. CONCLUSIONS: We herein described a rare case of nontuberculous mycobacteria associated with bronchial atresia. We believe that our case will add to our understanding and recognition of the spectrum of this rare condition. Reference #1: Matsuoka K, Ueda M, Miyamoto Y. Mycobacterium avium infection complicating congenital bronchial atresia. Asian Cardiovasc Thorac Ann 2016 Oct;24(8):808-810. Reference #2: Liebow AA. The J. Burns Amberson lecture--pulmonary angiitis and granulomatosis. Am Rev Respir Dis 1973 Jul;108(1):1-18. DISCLOSURES: No relevant relationships by Yuri Hiramatsu, source=Web Response No relevant relationships by Takafumi Kawabata, source=Web Response No relevant relationships by Yosuke Murakami, source=Web Response No relevant relationships by Saori Nishizawa, source=Web Response No relevant relationships by Mitsukuni Sakabe, source=Web Response No relevant relationships by TAKUTO SUEYASU, source=Web Response No relevant relationships by Kazunori Tobino, source=Web Response