title: Mediastinal lymphadenopathy caused by Mycobacterium avium-intracellulare complex in a child with normal immunity: successful treatment with anti-mycobacterial drugs and laser bronchoscopy.
abstract: We report on the case of a 9-month-old Caucasian girl referred to our institution with a history of fever of unknown origin and wheezing, unresponsive to bronchodilator and anti-inflammatory therapy. Subsequent investigation led to a diagnosis of mediastinal lymphadenopathy caused by Mycobacterium avium-intracellulare (MAI). The infected lymph tissue infiltrated and obstructed the right bronchus and significantly compressed the left bronchus to the point of near closure. Given the high degree of morbidity and potential mortality from thoracic surgery in this patient, we treated her with a combination of anti-mycobacterial drugs (rifabutin, clarithromycin, ciprofloxacin, clofazimine, amikacin, ethambutol) and glucocorticoids to relieve airway compression. The endobronchial granulation tissue was resected by laser bronchoscopy. This combined approach led to eventual normalization of radiologic and endoscopic findings, and the anti-mycobacterial chemotherapy was discontinued 12 months after the first bronchoalveolar lavage culture was negative for MAI. The patient remains asymptomatic 1 year after completion of this course of therapy. We suggest that mediastinal lymphadenopathy with bronchial infiltration and extrinsic airway compression caused by MAI in otherwise healthy children can be successfully treated with aggressive chemotherapy, glucocorticoids, and laser bronchoscopy.
authors.affiliation: Department of Pediatrics, University of North Carolina Hospitals, Chapel Hill, USA.
authors.forename: G
authors.initials: G
authors.lastname: Piedimonte
authors.forename: E T
authors.initials: ET
authors.lastname: Wolford
authors.forename: L A
authors.initials: LA
authors.lastname: Fordham
authors.forename: M W
authors.initials: MW
authors.lastname: Leigh
authors.forename: R E
authors.initials: RE
authors.lastname: Wood
mesh_terms: D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D001999:Bronchoscopy; D004359:Drug Therapy, Combination; D005260:Female; D006097:Granulation Tissue / Q000601:surgery; D006801:Humans; D007223:Infant; D053685:Laser Therapy; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000904:Antibiotics, Antitubercular