Yamanaka Toshiaki, Okamoto Hideyuki, Hosoi Hiroshi
Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan.
BMJ Case Rep. 2013 Oct 16;2013:bcr2013200990. doi: 10.1136/bcr-2013-200990.
We experienced an extremely rare case in which combined antibacterial therapy for a non-tuberculous mycobacteria (NTM) infection of the parotid gland achieved a favourable outcome in an elderly immunocompetent patient. Although a 79-year-old man, who presented with swelling and fistula formation in the left parotid gland region, initially received combined antituberculous therapy due to a positive result of acid-fast staining, the lesion did not respond to these agents. Thereafter, since the culture examination did not detect Mycobacterium tuberculosis or NTM, we excluded tuberculosis and considered the possibility of an NTM infection caused by a rare mycobacterial species. Therefore, we switched to the clarithromycin-based antibacterial treatment for eight consecutive months without a surgical intervention, resulting in the complete disappearance of the lesion and no evidence of recurrence detected for 4 years. This conservative chemotherapy might be a feasible alternative to a surgical intervention for treatment against NTM infections of the parotid gland.
我们遇到了一个极为罕见的病例,在一名免疫功能正常的老年患者中,针对腮腺非结核分枝杆菌(NTM)感染的联合抗菌治疗取得了良好效果。一名79岁男性,左侧腮腺区出现肿胀和瘘管形成,由于抗酸染色结果呈阳性,最初接受了联合抗结核治疗,但病变对这些药物无反应。此后,由于培养检查未检测到结核分枝杆菌或NTM,我们排除了结核病,并考虑由罕见分枝杆菌引起NTM感染的可能性。因此,我们连续八个月改用基于克拉霉素的抗菌治疗,未进行手术干预,病变完全消失,且4年未检测到复发迹象。这种保守化疗可能是治疗腮腺NTM感染的手术干预的可行替代方案。