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Mycobacterial avium complex pulmonary infection

Russell TCR - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Mycobacterial avium complex pulmonary infection

History: Patient is a 49 y/o AD USN male with history of sarcoidosis presented to his PCM in early December with a 4 day history of dyspnea and myalgias. He was originally seen by a civilian provider and was given azitrhomycin 250mg which had no effect on his condition. Upon admission he noted fatigue, cough and pleuritic chest pain. His pulse oximetry was 88% while walking, whereas his normal baseline is 95%. His home medications include Advair and Spiriva. Pt was admitted to hospital for sarcoid exacerbation with an elevated WBC of 11.3. He was started on prednisone taper and levofloxacin 750mg QDay for 21 days. A Chest posterior-anterior and lateral x-ray showed RML and RUL opacity consistent with infection. A CT, PE protocol 1.25 mm contiguous axial images with IV contrast was performed which showed consolidation of the apical posterior segment of the right upper lobe consistent with pneumonia. The patient was discharged from the hospital. He returned to his PCM intermittently with very little improvement. In April he returned to his PCM with thick green sputum, fevers of 102.9 and nightsweats while on levofloxacin. A sputum sample was taken which showed candida albicans and AFB. The patient was isolated for TB at that time, and the reflexive PCR showed the AFB to be Mycobacterium avium complex (MAC) which is a Nontuberculous mycobacteria (NTM). A chest CT without contrast, 5 mm thick axial slices, was obtained which showed increased right middle lobe consolidation with a 2.4 cm cavitation and nearly resolved right upper lobe consolidation.

Findings: CT (09-Dec-2008) 1. No PE or DVT. 2. Consolidation of the apical posterior segment of the right upper lobe consistent with pneumonia. 3. Diffuse interstitial disease, pulmonary fibrosis and traction bronchiectasis consistent with history of sarcoidosis. Chest PA/Lat (09-Dec-2008): 1. Diminished right lower lobe infiltrative process. 2. Diffuse bilateral interstitial lung disease, not appreciably changed. 3. Persistent right apical pleural thickening. CT (06-Apr-2009) 1. Increased right middle lobe consolidation with a 2.4 cm cavitation. 2. Nearly resolved right upper lobe consolidation. 3. Traction bronchiectasis and fibrosis as described as can be seen with sarcoidosis. 4. At the lung bases, there are fibrotic and emphysematous like changes. 5. Stable mild mediastinal lymphadenopathy.

Ddx: • Sacoidosis exacerbation • TB • NTM • Pulmonary SCC • Fungal infection

Dxhow: Sputum sample light microscopy AF stain with reflexive PCR.

Exam: CV: RRR with out r/g/m Pulm: CTAB w/o r/r/w

No MeSH data available.


The PA is shown which has a RUL consolidative process consistent with pneumonia (superior arrow). Pleural thickening is also present in the right apex. The Pt has a history of sarcoidosis, and therefore have diffuse bilateral interstitial lung disease (inferior arrow).
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MPX1257_synpic48775: The PA is shown which has a RUL consolidative process consistent with pneumonia (superior arrow). Pleural thickening is also present in the right apex. The Pt has a history of sarcoidosis, and therefore have diffuse bilateral interstitial lung disease (inferior arrow).


Mycobacterial avium complex pulmonary infection

Russell TCR - MedPix (2009)

The PA is shown which has a RUL consolidative process consistent with pneumonia (superior arrow). Pleural thickening is also present in the right apex. The Pt has a history of sarcoidosis, and therefore have diffuse bilateral interstitial lung disease (inferior arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1257&req=5

MPX1257_synpic48775: The PA is shown which has a RUL consolidative process consistent with pneumonia (superior arrow). Pleural thickening is also present in the right apex. The Pt has a history of sarcoidosis, and therefore have diffuse bilateral interstitial lung disease (inferior arrow).

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Mycobacterial avium complex pulmonary infection

History: Patient is a 49 y/o AD USN male with history of sarcoidosis presented to his PCM in early December with a 4 day history of dyspnea and myalgias. He was originally seen by a civilian provider and was given azitrhomycin 250mg which had no effect on his condition. Upon admission he noted fatigue, cough and pleuritic chest pain. His pulse oximetry was 88% while walking, whereas his normal baseline is 95%. His home medications include Advair and Spiriva. Pt was admitted to hospital for sarcoid exacerbation with an elevated WBC of 11.3. He was started on prednisone taper and levofloxacin 750mg QDay for 21 days. A Chest posterior-anterior and lateral x-ray showed RML and RUL opacity consistent with infection. A CT, PE protocol 1.25 mm contiguous axial images with IV contrast was performed which showed consolidation of the apical posterior segment of the right upper lobe consistent with pneumonia. The patient was discharged from the hospital. He returned to his PCM intermittently with very little improvement. In April he returned to his PCM with thick green sputum, fevers of 102.9 and nightsweats while on levofloxacin. A sputum sample was taken which showed candida albicans and AFB. The patient was isolated for TB at that time, and the reflexive PCR showed the AFB to be Mycobacterium avium complex (MAC) which is a Nontuberculous mycobacteria (NTM). A chest CT without contrast, 5 mm thick axial slices, was obtained which showed increased right middle lobe consolidation with a 2.4 cm cavitation and nearly resolved right upper lobe consolidation.

Findings: CT (09-Dec-2008) 1. No PE or DVT. 2. Consolidation of the apical posterior segment of the right upper lobe consistent with pneumonia. 3. Diffuse interstitial disease, pulmonary fibrosis and traction bronchiectasis consistent with history of sarcoidosis. Chest PA/Lat (09-Dec-2008): 1. Diminished right lower lobe infiltrative process. 2. Diffuse bilateral interstitial lung disease, not appreciably changed. 3. Persistent right apical pleural thickening. CT (06-Apr-2009) 1. Increased right middle lobe consolidation with a 2.4 cm cavitation. 2. Nearly resolved right upper lobe consolidation. 3. Traction bronchiectasis and fibrosis as described as can be seen with sarcoidosis. 4. At the lung bases, there are fibrotic and emphysematous like changes. 5. Stable mild mediastinal lymphadenopathy.

Ddx: • Sacoidosis exacerbation • TB • NTM • Pulmonary SCC • Fungal infection

Dxhow: Sputum sample light microscopy AF stain with reflexive PCR.

Exam: CV: RRR with out r/g/m Pulm: CTAB w/o r/r/w

No MeSH data available.