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Kim, Lee, Lee, Lee, Park, Jung, Son, Yoon, Shim, Kang, Park, Kim, Chang, Kim, and Moon: Non-tuberculous Mycobacterial Lung Disease Presenting as a Solitary Pulmonary Nodule
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 69(1): 43-47.

Published online: 31 July 2010

DOI: https://doi.org/10.4046/trd.2010.69.1.43

Non-tuberculous Mycobacterial Lung Disease Presenting as a Solitary Pulmonary Nodule

Song Yee Kim, M.D.1, Kyung Jong Lee, M.D.1, Sang Hoon Lee, M.D.1, Sang Kook Lee, M.D.1, Byung Hoon Park, M.D.1, Ji Ye Jung, M.D.1, Ji Young Son, M.D.1, Yoe Wun Yoon, M.D.1, Hyo Sup Shim2, Young Ae Kang, M.D.1, 3, Moo Suk Park, M.D.1, 3, Young Sam Kim, M.D.1, 3, Joon Chang, M.D.1, 3, Se Kyu Kim, M.D.1, 3, Jin Wook Moon, M.D.1, 3

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

3The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Jin Wook Moon, M.D. Department of Internal Medicine, Yonsei University College of Medicine, 250, Seongsan-no, Seodaemun-gu, Seoul 120-752, Korea. Phone: 82-2-2228-1996, Fax: 82-2-393-6884, jwmoon@yuhs.ac

Received 3 February 2010       Accepted 10 March 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

We report a case of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule (SPN). A 35-year-old male was admitted due to a SPN in the right upper lobe which was detected on the chest radiography being examed due to recurrent cough for 1 year. The computed tomography (CT) revealed a spiculated nodule containing air-bronchogram, which was suspicious of malignancy. We performed transbronchial biopsy and the pathology showed granulomatous inflammation with caseous necrosis. Under the presumptive diagnosis of pulmonary tuberculosis, we started anti-tuberculous medication including isoniazid, rifampin, ethambutol, and pyrazinamide. In one month, however, the sputum culture was positive for Mycobacterium intracellulare. The follow-up chest CT showed slight aggravation of the previous lesions. Under the final diagnosis of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule, we changed the regimen to rifampin, ethambutol, and clarithromycin. The follow-up chest CT after the completion of treatment, revealed resolution of the previous lesions.

Keywords: Mycobacterium Infections, Atypical, Solitary Pulmonary Nodule, Tuberculosis

Figures and Tables

Figure 1
The initial chest X-ray shows a nodular opacity in the right upper lung field.
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Figure 2
The initial chest CT shows a spiculated nodule with airbronchogram in the right upper lobe.
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Figure 3
The histologic finding of the transbronchial biopsy specimen shows chronic granulomatous inflammation with caseous necrosis (H&E stain, ×100).
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Figure 4
The chest CT reveals multiple newly-developed centrilobular nodules after the completion of six-month anti-tuberculous chemotherapy.
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Figure 5
The follow-up chest CT after the completion of anti-Mycobacterium intracellulare chemotherapy shows the resolution of previous nodular lesions.
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