Waldron Ruth, Waldron Dympna, McMahon Eileen, Reilly Leona, Riain Una Ni, Fleming Catherine, O'Regan Anthony
Department of Clinical Microbiology, Galway University Hospital, Ireland.
Department of Palliative Medicine, Galway University Hospital, Ireland.
Respir Med Case Rep. 2019 Feb 28;26:307-309. doi: 10.1016/j.rmcr.2019.02.022. eCollection 2019.
is a rapidly growing nontuberculous mycobacterium which has been associated with several infections including cellulitis, osteomyelitis, lymphadenitis, infected pacemakers and bursitis but it is a rare cause of respiratory infection.
In this case report we describe a 51-year-old woman who presented with a 6-week history of non-productive cough, pleuritic chest pain and weight loss. She had a history of gastric adenocarcinoma managed with a distal oesophagectomy and total gastrectomy and consequentially suffered severe post-operative gastric reflux. Initial cultures were negative but following a VATS lung biopsy was cultured and histology revealed an organising pneumonia. Treatment was with a prolonged course of steroids, amikacin and meropenem followed by oral ciprofloxacin and doxycycline. Ongoing gastric dysmotility and weight loss showed clinical improvement with a novel approach of a combination of prokinetics and somatostatin analogues controlling risk of repeat aspiration and improving symptom control.
This is an unusual case of organising pneumonia related to infection and highlights the importance of mycobacterial culture in unusual and unresolving cases of organising pneumonia. The importance of controlling symptoms related to gastric dysmotility and aspiration is also addressed.
是一种快速生长的非结核分枝杆菌，与包括蜂窝织炎、骨髓炎、淋巴结炎、感染的起搏器和滑囊炎在内的多种感染有关，但它是呼吸道感染的罕见病因。
在本病例报告中，我们描述了一名51岁女性，她有6周的干咳、胸膜炎性胸痛和体重减轻病史。她有胃腺癌病史，接受了远端食管切除术和全胃切除术，因此术后出现严重的胃反流。初始培养结果为阴性，但在电视辅助胸腔镜肺活检后培养出 ，组织学显示为机化性肺炎。治疗采用了长期的类固醇、阿米卡星和美罗培南疗程治疗，随后口服环丙沙星和多西环素。持续的胃动力障碍和体重减轻通过一种新的方法得到了临床改善，该方法将促动力药和生长抑素类似物联合使用，控制了再次误吸的风险并改善了症状控制。
这是一例与 感染相关的不寻常的机化性肺炎病例，强调了在不寻常和未解决的机化性肺炎病例中进行分枝杆菌培养的重要性。还讨论了控制与胃动力障碍和误吸相关症状的重要性。
