Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules

• Published in: The international journal of tuberculosis and lung disease Vol. 14; no. 12; pp. 1635 - 1640
• Main Authors: LIM, J, LYU, J, CHOI, C.-M, OH, Y.-M, LEE, S. D, KIM, W. S, KIM, D. S, LEE, H, SHIM, T. S
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.12.2010; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Biopsy, Needle; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Mycobacterium - isolation & purification; Mycobacterium avium; Mycobacterium Avium-Intracellulare Infection; Mycobacterium avium-intracellulare Infection - diagnosis; Mycobacterium avium-intracellulare Infection - drug therapy; Mycobacterium avium-intracellulare Infection - microbiology; Mycobacterium Infections - diagnosis; Mycobacterium Infections - drug therapy; Mycobacterium Infections - microbiology; Pneumology; Registries; Republic of Korea; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Solitary Pulmonary Nodule; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - drug therapy; Solitary Pulmonary Nodule - microbiology; Treatment Outcome; Tuberculoma; Tuberculosis and atypical mycobacterial infections; Tumors of the respiratory system and mediastinum; Republic of Korea; Pseudotumor; Lung disease; Respiratory disease; Mycobacterium avium; Tuberculoma; Mycobacterial infection; Mycobacterium intracellulare; Infection; Tuberculosis; Solitary pulmonary nodule; Mycobacteriales; Mycobacterium avium-intracellulare infection; Bacteriosis; Mycobacteriaceae; Bacteria; Tumor; Actinomycetes; Pneumology
• ISSN: 1027-3719; 1815-7920; 1815-7920

SETTING: South Korea, 2005-2007.BACKGROUND: Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules (NTM-SPN) are rare and may be misdiagnosed as tuberculoma.DESIGN: Eleven NTM-SPN patients were enrolled retrospectively and compared with two groups each of 33 patients with upper lobe cavitary (UC) and nodular bronchiectatic (NB) type NTM diseases, respectively.RESULTS: The patients' median age was 52 years. Compared with UC-type disease, NTM-SPN patients showed female (n = 9) and never smoker (n = 8) predominance and fewer comorbidities (n = 0; P < 0.05 for each). Mycobacterium avium (n = 9) was predominant in NTM-SPN patients, followed by M. intracellulare (n = 2), whereas M. intracellulare was most frequently isolated from patients with both UC- and NB-type NTM (P < 0.05). The nodules were a median of 2.3 cm in diameter (range 1.6-6.3 cm) and were distributed evenly in all lobes. In all patients, percutaneous needle aspiration/biopsy was performed with a median 71 days of diagnostic delay. Ten patients successfully completed treatment, and one showed spontaneous reduction of nodule size without treatment. Reverse blot hybridisation assays of six DNA samples identified four subjects with M.avium-intracellulare complex (MAC), in line with conventional test data.CONCLUSION: NTM-SPN was caused exclusively by MAC. Although clinical outcome was favourable, confirmatory diagnosis was delayed. Molecular methods are needed for early diagnosis of NTM-SPN.