Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: a case report.
Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: a case report.
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DOI：
10.1186/s13256-015-0723-4
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发表时间：
2015-10-26
影响因子：
1
通讯作者：
Betsuyaku T
中科院分区：
文献类型：
--
作者：
Asakura T;Ishii M;Haraguchi M;Kamiyama I;Kohno M;Sakamaki H;Emoto K;Hayashi Y;Sugiura H;Kawada I;Soejima K;Namkoong H;Tasaka S;Hasegawa N;Betsuyaku T
鸟分枝杆菌复合体（MAC）肺部疾病表现为孤立性肺结节（MAC-SPN），通常无症状，在中老年更常见，与肺癌或结核球相似。我们在此报告一例MAC-SPN的免疫功能正常的年轻成人患者，表现为持续性胸痛和亚急性进行性结节与高强度的18F-氟脱氧葡萄糖摄取。切除标本的组织学检查显示胸膜炎，这是一种罕见的发现MAC-SPN。一位36岁的日本男性，因胸痛和亚急性进行性肺结节就诊。正电子发射断层扫描-计算机断层扫描显示结节中高强度的18F-氟脱氧葡萄糖摄取。由于他持续胸痛和亚急性进展性结节，使用视频辅助胸腔镜手术进行楔形切除术。组织学检查显示上皮样肉芽肿和胸膜炎，肺组织培养为分枝杆菌阳性。avium这是第一个报告的MAC-SPN发生持续性胸痛，这表明MAC应考虑在孤立性肺结节的鉴别诊断，即使是患者谁经历持续性胸痛。在本病例中，电视辅助胸腔镜手术切除是诊断和治疗可能为恶性的MAC-SPN的合理方法，特别是MAC可以通过切除的肺组织培养和组织学确认来诊断。
Mycobacterium avium complex (MAC) lung disease presenting as a solitary pulmonary nodule (MAC-SPN) is often asymptomatic, is more common in middle to old age, and mimics lung cancer or tuberculoma. We report herein a case of MAC-SPN in an immunocompetent young adult patient, presenting with persistent chest pain and a subacutely progressive nodule with high intense 18F-fluorodeoxyglucose uptake. Histological examination of resected specimens revealed pleurisy, which is a rare finding of MAC-SPN. A 36-year-old Japanese male presented with chest pain and a subacutely progressive pulmonary nodule. Positron emission tomography-computed tomography showed high intense 18F-fluorodeoxyglucose uptake in the nodule. Owing to his continuous chest pain and subacutely progressive nodules, wedge resection was performed using video-assisted thoracoscopic surgery. Histological examination revealed an epithelioid granuloma and pleurisy, and the lung tissue culture was positive for mycobacteria identified as M. avium. This is the first report of MAC-SPN occurring with persistent chest pain, suggesting that MAC should be considered in the differential diagnosis of a solitary pulmonary nodule, even for patients who experience persistent chest pain. As in the present case, surgical resection with video-assisted thoracoscopic surgery is a reasonable approach to the diagnosis and treatment of MAC-SPN with possible malignancy, especially as MAC can be diagnosed using resected lung tissue culture with histological confirmation.