Mycobacterium avium Infection Presenting as Endobronchial Lesions in an Immunocompetent Patient

Atypical mycobacterial infection masquerading as an endobronchial growth in an immunocompromised host

Non-tuberculous mycobacteria (NTM) are ubiquitous organisms. Endobronchial growth as a presenting feature of NTM disease is uncommon. Here we present a case of a patient with retroviral disease on antiretroviral therapy, presenting with cough, wheezing and exertional dyspnoea. High-resolution CT showed a partial obstruction of the left main bronchus (LMB). Bronchoscopy showed an endobronchial growth in the distal LMB. An endobronchial biopsy showed non-necrotising granulomas; bronchial wash for acid-fast bacilli was positive and culture grew Mycobacterium avium complex. He was treated with a combination therapy of clarithromycin, rifampicin and ethambutol. Repeat bronchoscopy after 6 weeks of therapy showed complete resolution of the endobronchial growth.

Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient Treated with Methotrexate

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.

Endobronchial Mycobacterium avium Infection in an Immunocompetent Patient

Although Mycobacterium avium complex (MAC) is the most common pathogen in nontuberculous mycobacterial (NTM) pulmonary diseases, endobronchial lesions caused by MAC infections are very rare even in an immunocompromised host. Herein, we describe the case of a 59-year-old, HIV-negative and non-immunocompromised woman who developed multifocal pulmonary infiltrations with endobronchial lesion caused by M. avium. Bronchoscopic examination revealed white- and yellow-colored irregular mucosal lesions in the bronchus of the left lingular division. M. avium was identified using sputum culture and bronchial washing fluid culture. Following the recommendations of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA), the patient was begun on treatment with antimycobacterial drugs. After treatment, pneumonic infiltration decreased.

Mycobacterium avium complex infection presenting as an endobronchial mass in a patient with acquired immune deficiency syndrome

Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with AIDS (acquired immune deficiency syndrome). Pulmonary involvement of MAC may range from asymptomatic colonization of the respiratory tract to invasive parenchymal or cavitary disease. However, endobronchial lesions with MAC infection are rare in immunocompetent and immunosuppressed hosts. Here, we report MAC infection presenting as an endobronchial mass in a patient with AIDS.