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- Megumu Osaki, Takehiko Kobayashi, Shiomi Yoshida, Shigeki Shimizu, and Kazunari Tsuyuguchi.
- Department of Respiratory Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.
- Intern. Med. 2023 Apr 15; 62 (8): 123712411237-1241.
AbstractNontuberculous mycobacterial lung disease usually manifests as a chronic pulmonary infection. We herein report a fatal case of Mycobacterium avium pleurisy in a man with a refractory bronchopleural fistula that led to rapidly progressive pneumonia. A post-mortem transbronchial biopsy was performed. Histopathology revealed an acute lung injury pattern and epithelioid granulomas. Variable number tandem repeat analyses and drug susceptibility testing revealed Mycobacterium avium had acquired macrolide resistance during chemotherapy with rifampicin, ethambutol, and clarithromycin. Clinicians should be aware that Mycobacterium avium pleurisy with bronchopleural fistula can lead to fatal pneumonia, especially in patients with persistently positive cultures despite multidrug treatment.
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