Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
BMJ Case Rep. 2022 Mar 24;15(3):e247396. doi: 10.1136/bcr-2021-247396.
Non-tuberculous mycobacteria (NTM) are one of the predominant microbes observed in immunocompromised patients with structural lung disease. Especially in immunocompromised patients, the treating physician needs to be aware of concurrent lung infections with opportunistic pathogens. In this case report we present a man in his 60s with severe chronic obstructive pulmonary disease (COPD) and bullous emphysema, who was diagnosed with but with persistent clinical deterioration despite relevant treatment for NTM. A subsequent bronchoalveolar lavage (BAL) revealed elevated galactomannan antigen which, when seen in relation to imaging-findings of cavitating opacities with aggravating surrounding consolidation, raised suspicion of concurrent subacute invasive aspergillosis. Antifungal treatment was initiated but due to intolerable side effects was discontinued after only a few weeks. This case highlights the importance of concurrent testing for pulmonary aspergillosis in NTM patients and vice versa before treatment initiation and if the disease and symptoms are progressing despite relevant treatment.
非结核分枝杆菌（NTM）是结构性肺病合并免疫功能低下患者中主要观察到的微生物之一。特别是在免疫功能低下的患者中，治疗医生需要注意潜在的机会性病原体肺部感染。在本病例报告中，我们介绍了一位 60 多岁的男性，患有严重的慢性阻塞性肺疾病（COPD）和大疱性肺气肿，他被诊断为 NTM 感染，但尽管进行了相关治疗，仍持续临床恶化。随后的支气管肺泡灌洗（BAL）显示升高的半乳甘露聚糖抗原，当与有空洞性混浊并伴有周围实变加重的影像学表现相结合时，提示并发亚急性侵袭性曲霉病。开始进行抗真菌治疗，但由于不可耐受的副作用，仅几周后就停药了。本病例强调了在开始治疗前，以及在疾病和症状持续进展但经过相关治疗后，对 NTM 患者进行并发肺曲霉病检测以及对肺曲霉病患者进行并发 NTM 检测的重要性。
