Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: a case report.
BACKGROUND
Mycobacterium avium complex (MAC) lung disease presenting as a solitary pulmonary nodule (MAC-SPN) is often asymptomatic, is more common in middle to old age, and mimics lung cancer or tuberculoma. We report herein a case of MAC-SPN in an immunocompetent young adult patient, presenting with persistent chest pain and a subacutely progressive nodule with high intense (18)F-fluorodeoxyglucose uptake. Histological examination of resected specimens revealed pleurisy, which is a rare finding of MAC-SPN.


METHODS
A 36-year-old Japanese male presented with chest pain and a subacutely progressive pulmonary nodule. Positron emission tomography-computed tomography showed high intense (18)F-fluorodeoxyglucose uptake in the nodule. Owing to his continuous chest pain and subacutely progressive nodules, wedge resection was performed using video-assisted thoracoscopic surgery. Histological examination revealed an epithelioid granuloma and pleurisy, and the lung tissue culture was positive for mycobacteria identified as M. avium.


CONCLUSIONS
This is the first report of MAC-SPN occurring with persistent chest pain, suggesting that MAC should be considered in the differential diagnosis of a solitary pulmonary nodule, even for patients who experience persistent chest pain. As in the present case, surgical resection with video-assisted thoracoscopic surgery is a reasonable approach to the diagnosis and treatment of MAC-SPN with possible malignancy, especially as MAC can be diagnosed using resected lung tissue culture with histological confirmation.
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. takanori.asakura@gmail.com.
Takanori
T
Asakura
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. ishii@z6.keio.jp.
Makoto
M
Ishii
Department of Medicine, Nippon Kokan Hospital, 1-2-1 Kokan-dori, Kawasaki, Kanagawa, 210-0852, Japan. mizuha-h@rf7.so-net.ne.jp.
Mizuha
M
Haraguchi
Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. i_kami@rc4.so-net.ne.jp.
Ikuo
I
Kamiyama
Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. kohno@1993.jukuin.keio.ac.jp.
Mitsutomo
M
Kohno
Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. sakamaki71@gmail.com.
Hiroyuki
H
Sakamaki
Division of Diagnostic Pathology, Keio University Hospital, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. emoto@a7.keio.jp.
Katsura
K
Emoto
Division of Diagnostic Pathology, Keio University Hospital, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. yuichirohayashi72@gmail.com.
Yuichiro
Y
Hayashi
Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Shinjuku, 160-8582, Japan. hsugiura@momo.so-net.ne.jp.
Hiroaki
H
Sugiura
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. ichirok@coral.plala.or.jp.
Ichiro
I
Kawada
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. ksoejima@cpnet.med.keio.ac.jp.
Kenzo
K
Soejima
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. hounamugun@gmail.com.
Ho
H
Namkoong
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. tasaka@cpnet.med.keio.ac.jp.
Sadatomo
S
Tasaka
Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. n-hasegawa@z8.keio.jp.
Naoki
N
Hasegawa
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. tbetsuyaku@z5.keio.jp.
Tomoko
T
Betsuyaku
D000328:Adult; D006099:Granuloma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D009162:Mycobacterium avium; D049268:Positron-Emission Tomography; D003074:Solitary Pulmonary Nodule / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D014396:Tuberculosis, Pleural / Q000175:diagnosis*