|Year : 2019 | Volume
| Issue : 4 | Page : 397-399
Secondary organizing pneumonia due to Mycobacterium abscessus lung disease: Case report and review of the literature
Keisuke Watanabe1, Akio Miyake2, Takeshi Kaneko1
1 Department of Pulmonology, Yokohama City University School of Medicine, Yokohama, Japan
2 Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
|Date of Submission||28-Aug-2019|
|Date of Acceptance||16-Oct-2019|
|Date of Web Publication||26-Nov-2019|
Department of Pulmonology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004
Source of Support: None, Conflict of Interest: None
A 59-year-old male, who had Mycobacterium abscessus lung disease and chronic obstructive pulmonary disease, visited our hospital because of dyspnea. Chest computed tomography showed ground-glass opacity and consolidation mainly in the left upper lobe. Antibiotics treatment with levofloxacin and tazobactam/piperacillin was not effective. He underwent bronchoscopy and based on pathological findings, organizing pneumonia (OP) was diagnosed. No other underlying factors causing OP, such as collagen vascular diseases, drug, or inhalation were detected. He had the diagnosis of secondary OP due to M. abscessus lung disease. Oral predonizolone with 30 mg was initiated, and the opacity improved rapidly. Secondary OP due to M. abscessus lung diseases should be considered during M. abscessus lung diseases when antibiotics and/or antimycobacterial drugs are not effective.
Keywords: Mycobacterium abscessus, nontuberculous mycobacteria, organizing pneumonia
|How to cite this article:|
Watanabe K, Miyake A, Kaneko T. Secondary organizing pneumonia due to Mycobacterium abscessus lung disease: Case report and review of the literature. Int J Mycobacteriol 2019;8:397-9
|How to cite this URL:|
Watanabe K, Miyake A, Kaneko T. Secondary organizing pneumonia due to Mycobacterium abscessus lung disease: Case report and review of the literature. Int J Mycobacteriol [serial online] 2019 [cited 2019 Dec 9];8:397-9. Available from: http://www.ijmyco.org/text.asp?2019/8/4/397/271467
| Introduction|| |
Secondary organizing pneumonia (OP) due to lung infection is reported in various pathogens. However, secondary OP caused by Mycobacterium abscessus is rare, and only three cases have been reported.,, Here, we report a case of secondary OP due to M. abscessus lung disease and review of the literature.
Written informed consent was obtained from the participant.
| Case Report|| |
A 59-year-old male, who had M. abscessus lung disease and chronic obstructive pulmonary disease (COPD), visited our hospital because of dyspnea in August 2017. He had the diagnosis of M. abscessus lung disease in February 2005 and received combination chemotherapy with clarithromycin and intravenous imipenem/cilastatin and amikacin, subsequently clarithromycin and faropenem. He also inhaled glycopyrronium/indacaterol for COPD. He was under long-term oxygen therapy for type II chronic respiratory failure (oxygen supply were 4 L/min on effort and 2 L/min at rest, respectively). His physical status was not remarkable except for SpO2 of 97% with oxygen 3.5 L/min. The peripheral white blood cells count was 10,400/μl (neutrophil 78.1%), and C-reactive protein was elevated (4.05 mg/dl). KL-6 and SP-D were within the normal limits (325 U/ml and 68.9 ng/ml, respectively). Arterial blood gas analyses under oxygen supply with 3.5 L/min were as follows: pH 7.370, PaO2 82.9 mmHg, PaCO2 62.3 mmHg, and HCO3 35.2 mEq/l. Chest computed tomography showed ground-glass opacity and consolidation mainly in the left upper lobe [Figure 1]a. Antibiotics treatment with levofloxacin and tazobactam/piperacillin was not effective.
|Figure 1: Radiological and pathological findings. Chest computed tomography showed ground glass opacity and consolidation mainly in left upper lobe (a). The opacity improved rapidly with oral predonizolone (b). The specimen obtained by transbronchial lung biopsy showed infiltration of inflammatory cells, mainly lymphocytes, and Masson body ([c] H and E, ×400. [d] EVG, ×400)|
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He underwent bronchoscopy, and the specimen obtained by transbronchial lung biopsy showed infiltration of inflammatory cells, mainly lymphocytes, and the Masson body [Figure 1]c and [Figure 1]d. Bronchoalveolar lavage was discontinued because of poor fluid recovery. Based on pathological findings, OP was diagnosed. No other underlying factors causing OP, such as collagen vascular diseases, drug, or inhalation were detected. Thus, he had the diagnosis of secondary OP due to M. abscessus lung disease. Oral predonizolone with 30 mg was initiated and the opacity improved rapidly [Figure 1]b. Oral predonizolone was tapered over a period of 6 months and withdrawn. During the follow-up of 2 years, he had no relapse of OP without predonizolone though M. abscessus lung disease had recurred two times.
| Discussion|| |
OP is divided into two types, cryptogenic OP and secondary OP. Many factors, such as lung infection, collagen vascular diseases, drug, or inhalation, were reported to cause OP. However, secondary OP due to M. abscessus lung diseases was rare manifestation.,, Including our case, four cases were reported [Table 1]. All were well responded to predonizolone. Of four patients, only one patient was reported to have relapse during predonizolone tapering.M. abscessus lung disease is difficult to treat due to resistance to many antibiotics.,, Thus, treatment success rate is low., In our case, OP did not relapse though M. abscessus lung disease recurred. It is unknown whether the recurrence of M. abscessus lung disease could cause relapse of OP. Further cases are needed to establish the clinical course of secondary OP due to M. abscessus lung disease.
|Table 1: Reported cases of secondary organizing pneumonia caused by Mycobacterium abscessus lung disease|
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Secondary OP due to M. abscessus lung disease should be considered during the course of M. abscessus lung disease when antibiotics and/or anti-mycobacterial drugs are not effective. In addition, secondary OP cases due to other nontuberculous mycobacteria (NTM) pathogens were also reported., As the NTM lung disease is increasing worldwide, pulmonologist might have more opportunity to see the NTM lung disease with OP.
Recently, diagnostic methods for NTM has made advance, including genetic testing.,M. abscessus is divided into three subspecies, M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii by genetic testing, though genetic testing was not performed in this case due to the insurance limitation. Precise detection of NTM pathogen might lead to a better understanding of clinical course of NTM lung diseases.
| Conclusion|| |
M. abscessus lung disease could cause secondary OP. Pulmonologist should consider secondary OP when antibiotics and/or anti-mycobacterial drugs are not effective in NTM subjects.
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Conflicts of interest
There are no conflicts of interest.
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