Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules
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.
Keywords: Mycobacterium avium-intracellulare infection; solitary pulmonary nodule; tuberculoma
Document Type: Regular Paper
Affiliations: 1: Division of Pulmonary & Critical Care Medicine, Gangneung Asan Hospital, Gangneung, Korea 2: Division of Pulmonary & Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea 3: Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Korea
Publication date: 01 December 2010
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