title: Nontuberculous mycobacterium diseases and chronic thromboembolic pulmonary hypertension.
abstract: OBJECTIVE
  We aimed to investigate the incidence and clinical characteristics of nontuberculous mycobacterial (NTM) pulmonary disease as a complication of chronic thromboembolic pulmonary hypertension (CTEPH).
  
  
  METHODS
  We conducted a retrospective study of 10 cases (5.6%) complicated by NTM pulmonary disease among 180 CTEPH patients.
  
  
  RESULTS
  Isolated species of avium (n=5), kansasii (n=2), intracellulare (n=1), abscessus (n=1) and fortuitum (n=1) were detected. NTM-infected lesions were observed in 33 of 180 (18.3%) lung segments obtained from the 10 patients, and complete obstruction due to chronic pulmonary thromboembolism was detected in 65 of the 180 segmental pulmonary arteries (36.1%). The NTM-infected segments in the CTEPH patients were significantly associated with obstructed rather than unobstructed pulmonary artery segments [25 of 65 (38.5%) vs. 8 of 115 (6.9%), p<0.01]. Cavitary, nodular, ectatic and ground-glass lesions were seen in 14, 22, seven and four of the 180 segments, respectively. Thirteen of the 14 cavitary (92.9%) lesions were located in non-perfused segments. Five patients with NTM disease underwent pulmonary endarterectomy (PEA). Of the 18 assessable NTM-infected segments in six NTM-treated patients, 17 were located in non-perfused segments and one was located in a previously perfused segment. All NTM-infected segments improved among three segments reperfused with PEA. In contrast, only eight (57.1%) NTM-infected segments improved among 14 continuously non-perfused segments. A lower body mass index was found to be a significant risk factor for NTM disease in the CTEPH patients.
  
  
  CONCLUSIONS
  This is the first report to document NTM-disease complications in patients with CTEPH. Reperfusion in cases of NTM lesions may improve the response to NTM drug therapy.
authors.affiliation: Department of Respiratory Medicine, Chibaken Saiseikai Narashino Hospital, Japan.
authors.forename: Fuminobu
authors.initials: F
authors.lastname: Kuroda
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanabe
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Igari
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sakao
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tada
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kasahara
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tatsumi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications*; D009170:Nontuberculous Mycobacteria; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult