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Solitary Pulmonary Nodules of Non-Tuberculous Mycobacterial Diseases Diagnosed After Surgery: A Case Series
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A1979 - Solitary Pulmonary Nodules of Non-Tuberculous Mycobacterial Diseases Diagnosed After Surgery: A Case Series
Author Block: Y. Tanaka, K. Taima, H. Tanaka, M. Itoga, Y. Ishioka, H. Sakamoto, T. Shiratori, J. Tsuchiya, S. Takanashi, S. Tasaka; Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
RATIONALE: An increasing number of patients with non-tuberculous mycobacteria (NTM) infections have been noticed in Japan. Although an NTM infection may present as a solitary pulmonary nodule (SPN), it is sometimes difficult to make a correct diagnosis.
METHODS: We retrospectively evaluated clinical and radiological features of six patients with SPNs who were diagnosed with NTM infections after surgical biopsy at our Hirosaki University Hospital between 2005 and 2017.
RESULTS: The patients comprised 5 men and a woman with a median age of 59 years. Four had smoking history, and two with chronic obstructive pulmonary disease. All 6 patients were immunocompetent and not associated with diabetes. The main locations of the nodules were the right upper lobe (n=4). The median diameter of the nodules was 24 mm (range, 12‐42 mm). None of the patients revealed centrilobular nodules or bronchiectasis on high-resolution computed tomography. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan was performed in three patients, and all of them showed abnormal uptake of FDG on the nodules (maximum standardized uptake value range, 3.5 - 4.8). Anti-glycopeptidolipid-core IgA antibody was positive in 1 patient. Since a definitive diagnosis was not made with bronchoscopy, they underwent nodule resection. In all the cases, lung pathology revealed epithelioid granulomas without caseous necrosis. NTMs were isolated from surgical specimens, including Mycobacterium avium in 4 patients, M. kansasii in 1, and M. avium-intracellulare complex in 1. All patients received postoperative chemotherapy including clarithromycin and are free of relapse.
CONCLUSIONS: It is sometimes difficult to make a diagnosis of NTM infections presenting as SPNs. Surgical resection may be helpful not only for correct diagnosis but also for curative treatment of the disease.
Author Block: Y. Tanaka, K. Taima, H. Tanaka, M. Itoga, Y. Ishioka, H. Sakamoto, T. Shiratori, J. Tsuchiya, S. Takanashi, S. Tasaka; Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
RATIONALE: An increasing number of patients with non-tuberculous mycobacteria (NTM) infections have been noticed in Japan. Although an NTM infection may present as a solitary pulmonary nodule (SPN), it is sometimes difficult to make a correct diagnosis.
METHODS: We retrospectively evaluated clinical and radiological features of six patients with SPNs who were diagnosed with NTM infections after surgical biopsy at our Hirosaki University Hospital between 2005 and 2017.
RESULTS: The patients comprised 5 men and a woman with a median age of 59 years. Four had smoking history, and two with chronic obstructive pulmonary disease. All 6 patients were immunocompetent and not associated with diabetes. The main locations of the nodules were the right upper lobe (n=4). The median diameter of the nodules was 24 mm (range, 12‐42 mm). None of the patients revealed centrilobular nodules or bronchiectasis on high-resolution computed tomography. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan was performed in three patients, and all of them showed abnormal uptake of FDG on the nodules (maximum standardized uptake value range, 3.5 - 4.8). Anti-glycopeptidolipid-core IgA antibody was positive in 1 patient. Since a definitive diagnosis was not made with bronchoscopy, they underwent nodule resection. In all the cases, lung pathology revealed epithelioid granulomas without caseous necrosis. NTMs were isolated from surgical specimens, including Mycobacterium avium in 4 patients, M. kansasii in 1, and M. avium-intracellulare complex in 1. All patients received postoperative chemotherapy including clarithromycin and are free of relapse.
CONCLUSIONS: It is sometimes difficult to make a diagnosis of NTM infections presenting as SPNs. Surgical resection may be helpful not only for correct diagnosis but also for curative treatment of the disease.
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