Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan.
Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Japan.
Intern Med. 2021 Oct 15;60(20):3267-3272. doi: 10.2169/internalmedicine.6693-20. Epub 2021 Apr 26.
A 78-year-old man was admitted to our hospital with a fever and left chest pain. Computed tomography showed multiple lung nodules, narrowing of the right bronchus intermedius with mediastinal lymphadenopathy, and an osteolytic lesion. Bronchoscopic findings showed rapid progression of multiple polypoid lesions and the bronchial stenosis. A biopsy of the endobronchial lesions revealed non-necrotizing granulomatous inflammation, and a tissue culture identified Mycobacterium avium. An anti-human immunodeficiency virus antibody was negative. Finally, anti-interferon-gamma (IFN-γ) autoantibodies were detected, and the patient was diagnosed with disseminated nontuberculous mycobacterium infection with anti-IFN-γ autoantibodies. Antimycobacterial therapy was effective, and radiographic findings, including the endobronchial lesions, were resolved.
一位 78 岁男性因发热和左侧胸痛入院。计算机断层扫描显示多个肺部结节,右中间支气管狭窄伴纵隔淋巴结病,以及溶骨性病变。支气管镜检查发现多个息肉样病变和支气管狭窄迅速进展。支气管内病变活检显示非坏死性肉芽肿性炎症,组织培养鉴定为鸟分枝杆菌。人类免疫缺陷病毒抗体阴性。最后,检测到抗干扰素-γ(IFN-γ)自身抗体,患者被诊断为播散性非结核分枝杆菌感染伴抗 IFN-γ 自身抗体。抗分枝杆菌治疗有效,包括支气管内病变在内的影像学发现得到解决。