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A case of Cavitary lung lesion suspicious for malignancy reveals Mycobacterium xenopi

A case of Cavitary lung lesion suspicious for malignancy reveals Mycobacterium xenopi

Dr.Sumit Fogla and associates have reported a case of Cavitary lung lesion suspicious for malignancy which reveals infection by  Mycobacterium xenopi.

The authors report the case of a 68-year-old gentleman who presented with musculoskeletal chest pain which appeared suddenly when he bent over with his dog. The chest pain was localized to the left lower chest and increased with movement and deep breathing. The patient did not complain weight loss, night sweat, fever or chill. He complained ofmild cough, with expectoration of whitish mucus.

Imaging revealed cavitary chest lesion in the right upper lobe, which was initially suspected to be lung cancer. The patient had a 50-year-old history of smoking 2 packs per day. PET CT imaging did not reveal any specific activity. Needle biopsy and bronchoalveolar lavage, however, did not reveal any malignant cells. Rather, necrotic tissues were observed.

A wedge resection of the lung mass was performed. No common organisms or fungi could be grown. However, acid fast bacilli were observed in clumps. The morphology hinted towards non-tuberculous mycobacterial organism(s). Molecular studies revealed infection with Mycobacterium xenopi. The patient was started on an anti-tuberculous regimen of INH, rifampicin, ethambutol and PZA, withpyridoxine. The patient is a Vietnam veteran and complained of exposure to dust from a bird’s nest and asbestos exposure in childhood, but no specific exposure to tuberculosis. The patient had an uneventful recovery post-surgery.He complained of some nausea after initiation of the antituberculous medications, but his pain subsided with time. The patient had diabetes, though specific reasons of compromise of immune status could not be pinpointed as causative of his nontuberculous mycobacterial lung infection.

Mycobacterium, the organism that is known to cause tuberculosis, have multiple species, likely greater than 500. It is widely distributed in the environment. It can cause disease even in cold-blooded animals like fish, turtle, snakes and frogs (as in our report). Piscine (fish) tuberculosis is mostly caused by Mycobacterium marinum, but any of these organisms in water can cause infections.
Mycobacterium xenopi is a thermophilic organism (grows in hot water) and is often found in hot water outlets in hospital systems.
Infections in humans is mainly related to depressed immune function. As you know, this compromise of body’s defense occurs in diabetes, someone on steroids or with infections like HIV/AIDS.

Source: self

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