Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan.
J Infect Chemother. 2013 Aug;19(4):588-92. doi: 10.1007/s10156-012-0518-0. Epub 2012 Nov 30.
Pneumothorax in patients with pulmonary Mycobacterium avium complex (MAC) disease is considered to be a rare complication, and little is known about its clinical course. In this study, we aimed to define the clinical features, outcome, and prevalence of pneumothorax in patients with pulmonary MAC disease. A retrospective review of medical records identified eight men and ten women (mean age, 75 years) with active pulmonary MAC disease complicated by pneumothorax between 2003 and 2010 in our institution. None of the patients was positive for HIV infection. Pneumothorax occurred in the right lung in 12 patients and in the left in six. All but one patient had MAC disease in both lungs, and 12 patients had widespread lesions covering a total area larger than one lung field. Seven of the 18 patients (39 %) were forced to undergo surgery following unsuccessful thoracic drainage. Five patients experienced recurrence during the study period and two others eventually developed chronic pneumothorax. The complication rate of pneumothorax was calculated on the bases of the total number of patients with active pulmonary MAC disease during the same period. The overall complication rate of pneumothorax was as high as 2.4 % (18 of 746 patients with MAC disease). In conclusion, the incidence of pneumothorax in patients with active pulmonary MAC disease was unexpectedly high, especially in patients who were elderly and had advanced MAC disease. This condition is often difficult to treat and can recur easily.
肺结核合并肺鸟分枝杆菌复合体（MAC）病患者的气胸被认为是一种罕见的并发症，其临床病程知之甚少。在本研究中，我们旨在确定肺结核合并 MAC 病患者气胸的临床特征、结局和发生率。回顾性分析了我院 2003 年至 2010 年间 18 例因气胸合并活动性肺结核住院的患者的病历，其中男性 8 例，女性 10 例（平均年龄 75 岁）。所有患者均未感染 HIV。12 例患者气胸发生在右侧，6 例发生在左侧。除 1 例外，所有患者均为双肺 MAC 病，12 例患者肺部广泛受累，病变总面积大于 1 个肺野。18 例患者中有 7 例（39%）在胸腔引流失败后被迫接受手术。5 例患者在研究期间复发，另有 2 例最终发展为慢性气胸。气胸的并发症发生率是基于同期活动性肺结核患者总数计算的。气胸的总并发症发生率高达 2.4%（746 例 MAC 病患者中有 18 例）。总之，活动性肺结核合并 MAC 病患者的气胸发生率出人意料地高，尤其是老年和 MAC 病晚期患者。这种情况通常很难治疗，容易复发。
