대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Non-tuberculous mycobacterium infection

Radiologic Findings

Fig.1 Chest PA
: Multiple well-defined masses in both lungs
Fig. 2 Chest CT
: Multiple well-defined masses with low attenuation in the non-contrast CT and some small centrilobular nodules adjacent to the masses in the left lung.
Fig. 3 Follow-up chest CT in 9 days after antibiotic and antifungal treatment
: The masses were increased in extent with cavity formation
Fig. 4 Chest PA in 3 months after NTM treatment
: The masses were decreased.

Brief Review

A 78-year-old male patient treated with *JAKAVI® for primary meylofibrosis visited our hostpital complaining of cough and sputum.
The chest CT showed several masses in both lungs and small centrilobular nodules in the left lower lung zone. He underwent a percutaneous core-needle biopsy for the mass and the specimen was diagnosed with acute inflammation consistent with pneumonia. However, despite antibiotic and antifungal treatment, the masses were increased with cavity formation and the small centrilobular nodules were also increased in extent. After about 2 weeks, M. intracellulare was positive in the mycobacterium cultures. He started the NTM treatment and a follow up chest radiograph in 3 months revealed decreased masses in both lungs.
The upper lobe cavitary and the nodular bronchiectatic forms have been reported to be two common CT patterns of NTM infections in immunocompetent patients. The cavitary form is usually seen in older, white males with underlying chronic pulmonary disease. CT findings of the cavitary form include upper lobe cavitary lesions and nodules adjacent to the foci of disease. The cavities are usually small and thin walled. The nodular bronchiectatic form is usually seen in middle-aged or older females with no predisposing factors. CT findings of the nodular bronchiectatic form include small centrilobular nodules with bronchiectasis, usually occurring in the same lobe.
Song at al. reported ill-defined nodules and large opacities accompanying cavity change were more common finding in non-AIDS immunocompromised patient including those with diabetes mellitus than immunocompetent patients.

* JAKAVI® (ruxolitinib) for the treatment of myelofibrosis and for the treatment of polycythaemia vera in patients resistant to or intolerant of hydroxyurea.

References

Koh, W. J., Kwon, O. J., & Lee, K. S. (2002). Nontuberculous mycobacterial pulmonary diseases in immunocompetent patients. Korean Journal of Radiology, 3(3), 145-157.
Lee, Y., Song, J. W., Chae, E. J., Lee, H. J., Lee, C. W., Do, K. H., ... & Shim, T. S. (2013). CT findings of pulmonary non-tuberculous mycobacterial infection in non-AIDS immunocompromised patients: a case-controlled comparison with immunocompetent patients. The British journal of radiology, 86(1024), 20120209.

Keywords