Cohen Leah, Guarner Jeannette, Hunt William R
Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 1365 Clifton Road NE, The Emory Clinic, Building A - Suite 3244, Atlanta, GA, 30322, USA.
Department of Pathology and Laboratory Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
J Med Case Rep. 2017 Aug 28;11(1):240. doi: 10.1186/s13256-017-1392-2.
Lung transplantation remains an important potential therapeutic option for end-stage lung disease. It can improve quality of life and in some cases be a life-lengthening therapy. Despite the possible benefits, there are also many potential complications following transplantation. Here we describe a novel presentation of nontuberculous mycobacterium manifesting as an endobronchial mass developing 4 years after lung transplantation.
A 66-year-old African-American woman presented with progressive dyspnea, cough, and persistent wheezing of 2 months' duration. She had a distant history of breast cancer and received bilateral lung transplantation due to end-stage pulmonary fibrosis 4 years prior to her current presentation. She denied fevers, but did endorse night sweats. She had diffuse expiratory wheezing on auscultation. Chest computed tomography imaging showed an endobronchial soft tissue lesion nearly occluding the left mainstem bronchus, which was concerning for endobronchial carcinoma. Rigid bronchoscopy demonstrated a fibrinous mass protruding into the left mainstem proximal to the anastomosis. A pathology report noted fragments of partially necrotic granulation tissue in addition to scant fragments of focally ulcerated bronchial mucosa. Both the tissue culture and bronchial wash stained positively for acid-fast bacilli and grew Mycobacterium avium complex.
Nontuberculous mycobacterium pulmonary disease is common post lung transplant and risk factors are related to immunosuppression and history of structural lung disease. Mycobacterium avium complex presenting as an endobronchial lesion in a patient post lung transplant is a novel presentation.
肺移植仍然是终末期肺病重要的潜在治疗选择。它可以改善生活质量，在某些情况下还能延长生命。尽管有这些潜在益处，但移植后也存在许多潜在并发症。在此，我们描述了一例非结核分枝杆菌的新病例，表现为肺移植4年后出现的支气管内肿物。
一名66岁的非裔美国女性，出现进行性呼吸困难、咳嗽和持续喘息2个月。她有乳腺癌病史，在此次就诊前4年因终末期肺纤维化接受了双侧肺移植。她否认发热，但承认盗汗。听诊有弥漫性呼气性哮鸣音。胸部计算机断层扫描成像显示一个支气管内软组织病变，几乎阻塞了左主支气管，怀疑是支气管内癌。硬质支气管镜检查显示在吻合口近端有一个纤维蛋白性肿物突入左主支气管。病理报告指出，除了少量局灶性溃疡支气管黏膜碎片外，还有部分坏死的肉芽组织碎片。组织培养和支气管灌洗的抗酸杆菌染色均为阳性，并培养出鸟分枝杆菌复合群。
非结核分枝杆菌肺病在肺移植后很常见，危险因素与免疫抑制和结构性肺病病史有关。鸟分枝杆菌复合群在肺移植患者中表现为支气管内病变是一种新的表现形式。
