The study of atypical mycobacterium infection
Case reportF78 years old male
Cheif complaintsFgeneral fatiguness, cough and sputum
Present illnessFSince 1993, he was indicated to have abnormal
chest roentgenogram. but it was considered to be the shadow of
old tuberculosis. On August, 1996, he complained of general
fatiguness, cough and sputum. He was examined by blood test
and chest roentgenogram. His phyisical examination revealed
decreased breathing sounds on both lungs. Rales are not audible
erythrocyte sedimentation rate one hour132mm,
2houurs164mm,
WBC5‚Q00A‚g‚‡‚‚8.9‚‡^‚„‚ŒC‚g‚ƒ‚”27.7“CCRP8.9mg/dlC
‚o‚o‚c‚“ skin test25mm,26mm
His chest roentgenogram showed infiltrate
on both apices, and
noticed cavity formation. Both hilus are
elevated.
Chest CT was performed.
There are multiple shadows with cavity on
both apices, and
small nodules adjacent to pleura. Radiologist
diagnosed his
roentgenogram compatible with atypical mycobacterium.
sputum smear:gaffky 3, sputum culture: positive
(+++), (colony
200-500), niacin test: negative
drug test:FSM 0(+++),20(++),200(+) PAS
0(+++),1(+++),10(+++)
INH 0(+++),01(+++),1(+++),5(+++) EB 0(+++),2.5(+++),5(+++)
RFP 0(+++),10(+++),50(+++)
atypical mycobacterium growing
on culture tube
His previous chest X-ray film was examined.
Chest roentgenogram on Nov,30.1993
chest antero-postero roentgenogrtam
comment:The CT appearance of pulmonary nontuberlulous
myco-
bacterial infection has been reported by
several authers.
The CT appearance of classical NTMB mimics
that seen in
patients with TB. Findings include apical
opacities, cavities,
that may be smooth or irregular in appearance,
bronchiectasis
in regions of severe lung damage, pleural
thickening adjacent
to abnormal lung regions and small nodules
(0.5-2.0cm)
probably representing endobronchial spread
of infection.
Moor reviewed CT and HRCT findings in40 patients
with
culture positive for atypical mycobacteria.
Common findings
included bronchiestasis(80%), consolidation
or ground-glass
opacity(73%), nodules(70%), and evidence
of scarring and
vokume loss.
Moore EH, Atypical mycobacterial infection
in the lung:CT
appearance. Radiology:1993;187;777-782.
‚rwensen reported that CT findings with bronchiestasis
and
multiple small nodular lesions were diagnosed
as atypical
mycobactiral infection more than 80 percent.
Swensen SJ, Computed tomography in diagnosis
of Mycobacterium
avium-intracellulare complex in patients
with bronchiectasis.
Chest 1994;105;49-52.
The treatment of the patient is hard to achieve
because of
multiple drug resistance. Some paper repoted
clarithromycin
(CAM) is effective to treat the disease.
But his condition is
deterioration even using the drug,and fever
is worsening.
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info@chijimatsu.com
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referenceF
pathology of
atypical mycobacterium
University of Iowa, radiology
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