Department of Community Medicine for Respirology, Hematology and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Department of Internal Medicine, Local Incorporated Administrative Agency Tokushima Prefecture Naruto Hospital, Tokushima, Japan.
J Med Invest. 2024;71(3.4):327-331. doi: 10.2152/jmi.71.327.
A 71-year-old male was referred to our institution for further examination of chest abnormal shadow. A cavitation in the right apical region, a mass adjacent to the pleura in the right upper lobe, and a nodule in the right middle lobe were observed in a chest computed tomography. The sputum smear and culture of acid-fast bacilli were positive, and Mycobacterium heckeshornense (M. heckeshornense) was identified with the matrix-assisted laser desorption ionization time-of-flight mass spectroscopy. Moreover, computed tomography-guided biopsy of a mass adjacent to the pleura in the right upper lobe yielded the diagnosis of primary lung adenocarcinoma. Taken together, the patient was finally diagnosed as coexistence of pulmonary M. heckeshornense infection and primary lung cancer. An anti-mycobacterial treatment with rifampicin, ethambutol and clarithromycin and a combined chemotherapy were fairly successful for pulmonary M. heckeshornense infection and primary lung adenocarcinoma, respectively. These observations suggest that triple anti-mycobacterial therapy may contribute to good controls of M. heckeshornense infection and that careful selection of anti-cancer drugs against lung cancer might be lead to favorable outcomes even during the course of anti-mycobacterial treatment. To the best of our knowledge, this is the first report of pulmonary M. heckeshornense infection coexisted with lung cancer. J. Med. Invest. 71 : 327-331, August, 2024.
一位 71 岁男性因胸部异常阴影被转诊至我院。胸部计算机断层扫描观察到右肺尖区有空腔、右上肺叶邻近胸膜的肿块和右肺中叶的结节。痰涂片和抗酸杆菌培养阳性，基质辅助激光解吸电离飞行时间质谱鉴定为海克霍恩分枝杆菌（M. heckeshornense）。此外，对右上肺叶邻近胸膜的肿块进行了计算机断层扫描引导活检，诊断为原发性肺腺癌。综上所述，患者最终被诊断为肺部 M. heckeshornense 感染和原发性肺癌并存。利福平、乙胺丁醇和克拉霉素三联抗分枝杆菌治疗和联合化疗分别对肺部 M. heckeshornense 感染和原发性肺腺癌取得了较好的疗效。这些观察结果表明，三联抗分枝杆菌治疗可能有助于控制 M. heckeshornense 感染，并且在抗分枝杆菌治疗过程中，仔细选择针对肺癌的抗癌药物可能会带来良好的结果。据我们所知，这是首例肺部 M. heckeshornense 感染合并肺癌的报告。J. Med. Invest. 71: 327-331, August, 2024.
