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Nishizawa Y, Katsura H, Sasaki Y, Kudo R, Kizuki A, Horimoto A, Ishikawa M, Takagi K, Kikuchi K, Sakura H, Nitta K, Hoshino J, Ogawa T. Secondary spontaneous pneumothorax in a patient with resistant Mycobacterium abscessus infection and systemic sclerosis-associated interstitial lung disease: A case report. Respir Med Case Rep 2023; 46:101941. [PMID: 38025248 PMCID: PMC10661848 DOI: 10.1016/j.rmcr.2023.101941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Mycobacterium abscessus subsp. abscessus (MABA) is refractory and sometimes fatal especially in an immunocompromised patient. Also, MABA-associated pneumothorax is an extremely rare complication. We report a case of MABA pulmonary infection complicated pneumothorax treated successfully. A 69-year-old Japanese female with immunosuppressed systemic sclerosis-associated interstitial lung disease experienced left-sided secondary spontaneous pneumothorax. MABA was detected in the pleural effusion and blood culture. Microbial sensitivity test showed the MABA was sensitive to only amikacin, sitafloxacin, and clofazimine. Combination therapy with these antibiotics including azithromycin achieved remission within three weeks. In the treatment of MABA infection, compliance with microbial sensitivity test is crucial.
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Affiliation(s)
- Yoko Nishizawa
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Hideki Katsura
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Yuka Sasaki
- Center of Pulmonary Disease, National Hospital Organization Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Ryoma Kudo
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Aki Kizuki
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Ai Horimoto
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Motonao Ishikawa
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Kae Takagi
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Ken Kikuchi
- Department of Infectious Diseases, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Tetsuya Ogawa
- Department of Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1, Kohoku, Adachi-ku, Tokyo, 123-8558, Japan
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Bachar K, Shulimzon T, Segel MJ. Nontuberculous mycobacteria infections of the pleura: A systematic review. Respir Med 2022; 205:107036. [PMID: 36335889 DOI: 10.1016/j.rmed.2022.107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/11/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nontuberculous mycobacterial (NTM) pleuritis is an uncommon manifestation of NTM infection. Case reports and small case series have shown a variable clinical course and high mortality rates. OBJECTIVE To describe patients' characteristics, clinical presentation and outcomes of NTM pleural infections. METHODS A systematic review of cases of NTM pleural infections published in PubMed-indexed journals from 1980 to 2021. RESULTS A total of 206 cases of NTM pleural infections were found and analyzed. Fifty-eight percent of cases were males. The mean age was 57.5 yrs (range 9-87 yrs). Forty-three percent of patients were immunosuppressed, and 43% had a chronic lung disease; thirty-two percent had neither risk factor. In addition to the pleural infection, 67% of cases had a concurrent pulmonary NTM infection, and in 18 cases there was another extrapulmonary site of NTM infection. In 29% of cases the pleural infection was the sole manifestation of NTM disease. The most common isolated mycobacterium was Mycobacterium avium complex (65%). Fifty-three percent and 26% of patients required pleural effusion drainage and a surgical intervention, respectively, to treat the infection, in addition to anti-NTM chemotherapy. Forty percent of patients developed pneumothorax, 16% suffered from empyema, and 16.5% had broncho-pleural fistula. The reported mortality rate was 24%. CONCLUSION NTM pleural infections may arise in immunocompetent and immunosuppressed patients, with or without chronic lung disease or concurrent NTM pulmonary infection. These infections carry a poor prognosis and a high risk of complications requiring surgical interventions in addition to anti-NTM chemotherapy.
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Affiliation(s)
- Keren Bachar
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Israel.
| | - Tiberiu Shulimzon
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Michael J Segel
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Luttmann KF, Starnes VR, Rostad K, Girdhar KK, Duggan J. Pleural Effusion/Empyema With Mycobacterium kansasii. Cureus 2022; 14:e21300. [PMID: 35186562 PMCID: PMC8849488 DOI: 10.7759/cureus.21300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Mycobacterium kansasii is a nontuberculous mycobacterium that causes pulmonary symptoms, commonly associated with underlying conditions, including malignancy, prior transplant, and HIV. However, rarely does Mycobacterium kansasii present with pleural effusion. We present a case of a 56-year-old female who presented with dyspnea and chest pain, and sputum culture was positive for acid-fast bacilli. A CT scan revealed a left-sided pleural effusion. Based on a thorough review of the literature using Embase and PubMed, we found that only 22 cases of a Mycobacterium kansasii pleural effusion have been reported. We provide a discussion on maintaining a broad differential in the treatment of immunocompromised individuals with Mycobacterium infection.
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Nagao G, Okuzumi S, Kakimoto T, Minematsu N. Pulmonary Mycobacterium kyorinense infection secondary to cavitary pulmonary tuberculosis. IDCases 2022; 28:e01476. [PMID: 35313667 PMCID: PMC8933579 DOI: 10.1016/j.idcr.2022.e01476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Naoto Minematsu
- Correspondence to: Department of Internal Medicine, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino-shi, Tokyo 191-0062, Japan.
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Kho BG, Na YO, Park HK, Lee JK, Oh HJ, Park HY, Kim TO, Shin HJ, Kwon YS, Kim YI, Lim SC. Life-threatening Mycobacterium intracellulare pleuritis in an immunocompetent host: Case reports. Medicine (Baltimore) 2021; 100:e28342. [PMID: 34941139 PMCID: PMC8702258 DOI: 10.1097/md.0000000000028342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Nontuberculous mycobacteria (NTM)-associated pleuritis is a very rare disease. Here, we describe 2 cases of life-threatening Mycobacterium intracellulare-associated pleuritis in immunocompetent hosts. PATIENT CONCERNS A 78-year-old man with sudden onset-onset dyspnea (case 1) and an 80-year-old man with cough, sputum and fever (case 2) presented to our emergency room. DIAGNOSES Both the patients were diagnosed with Mycobacterium intracellulare-associated pleuritis. INTERVENTION In case 1, the patient underwent intubation with mechanical ventilation due to hypoxemic respiratory failure. Daily azithromycin, rifampin and ethambutol, and intravenous amikacin 3 times a week was administered. In case 2, the patient received daily azithromycin, rifampin and ethambutol, and intravenous amikacin 3 times a week. OUTCOMES In case 1, after receiving NTM treatment for 14 months, NTM-associated pleuritis was cured, with radiologic improvement. In case 2, however, bronchopleural fistula was developed. Despite tube drainage, air leak continued. The patient refused surgical management and eventually died of respiratory failure. LESSONS Pleural effusion arising from NTM lung disease located in the subpleural area should be considered a possible cause of NTM-associated pleuritis. Drainage and a multidrug regimen are required to treat NTM, and surgical treatment should be considered when complications occur.
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Affiliation(s)
- Bo-Gun Kho
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young-Ok Na
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hwa Kyung Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jae-Kyeong Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung-Joo Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ha-Young Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University Medical School, Gwangju, Republic of Korea
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