Abstract
BackgroundLung transplantation remains an important potential therapeutic option for end-stage lung disease. It can improve quality of life and in some cases be a life-lengthening therapy. Despite the possible benefits, there are also many potential complications following transplantation. Here we describe a novel presentation of nontuberculous mycobacterium manifesting as an endobronchial mass developing 4 years after lung transplantation.Case presentationA 66-year-old African-American woman presented with progressive dyspnea, cough, and persistent wheezing of 2 months’ duration. She had a distant history of breast cancer and received bilateral lung transplantation due to end-stage pulmonary fibrosis 4 years prior to her current presentation. She denied fevers, but did endorse night sweats. She had diffuse expiratory wheezing on auscultation. Chest computed tomography imaging showed an endobronchial soft tissue lesion nearly occluding the left mainstem bronchus, which was concerning for endobronchial carcinoma. Rigid bronchoscopy demonstrated a fibrinous mass protruding into the left mainstem proximal to the anastomosis. A pathology report noted fragments of partially necrotic granulation tissue in addition to scant fragments of focally ulcerated bronchial mucosa. Both the tissue culture and bronchial wash stained positively for acid-fast bacilli and grew Mycobacterium avium complex.ConclusionsNontuberculous mycobacterium pulmonary disease is common post lung transplant and risk factors are related to immunosuppression and history of structural lung disease. Mycobacterium avium complex presenting as an endobronchial lesion in a patient post lung transplant is a novel presentation.
Highlights
Lung transplantation remains an important potential therapeutic option for end-stage lung disease
Nontuberculous mycobacterium pulmonary disease is common post lung transplant and risk factors are related to immunosuppression and history of structural lung disease
Mycobacterium avium complex presenting as an endobronchial lesion in a patient post lung transplant is a novel presentation
Summary
Airway complications following lung transplant are relatively common [3]. Lung transplantation is associated with an increased risk for the development of de novo cancers [22, 23]. Given that our patient presented with a new endobronchial mass years after she underwent bilateral lung transplantation, we initially were very concerned for an endobronchial malignancy. Subsequent biopsy and pathology identified MAC as the etiology of her airway mass. Risk for NTM infection is higher in immunocompromised individuals; in individuals following lung transplantation, NTM infection typically presents as pleuropulmonary disease. To the best of our knowledge, this is the first case of NTM presenting as an endobronchial lesion in a recipient of a lung transplant
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