Multiple, severe lung infiltrates due to Mycobacterium avium-intracellulare in a patient with decompensated liver cirrhosis: Spontaneous resolution after a two-year follow-up.
A unique case of severe, multiple, microbiologically-confirmed pulmonary Mycobacterium avium-intracellulare lesions occurred in a female with decompensated liver cirrhosis, and went to cure after around 2 y despite the impossibility to deliver an effective antimicrobial chemotherapy, owing to the patient's intolerance. From an extensive literature review, we underline a possible mechanism prompting mycobacterial disease during advanced liver disease, while we retrieved only 2 described cases of possible spontaneous resolution of Mycobacterium terrae lung disease, although both were reported in patients without end-organ liver disease, who received a specific combined chemotherapy for an appreciable time period. On the other hand, while decompensated liver cirrhosis is more frequently complicated by a peritoneal localization of bacteria and very infrequently mycobacteria, the reported case represents the first severe pulmonary localization of multiple lesions due to Mycobacterium avium-intracellulare. Moreover, this extraordinary episode resolved spontaneously within the 2-y follow-up, as documented by bronchoalveolar lavage, culture, high-resolution CT scans, and scintigraphic examination.
Manfredi
Roberto
R
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna 'Alma Mater Studiorum', S. Orsola Hospital, Bologna, Italy. manfredi@med.unibo.it
Sabbatani
Sergio
S
Attard
Luciano
L
Chiodo
Francesco
F
D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008171:Lung Diseases / Q000188:drug therapy / Q000382:microbiology*; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy / Q000382:microbiology*; D012075:Remission, Spontaneous
D000995:Antitubercular Agents