Miliary pulmonary nodules due to Mycobacterium xenopi in a steroid-induced immunocompromised patient successfully treated with chemotherapy: a case report.
BACKGROUND
Mycobacterium xenopi-infected patients have a high prevalence of pulmonary cavities and nodules. However, the clinical course for patients with miliary nodules due to M. xenopi has not yet been reported.


METHODS
We encountered a case of miliary nodules with gradually worsening coughing and sputum production in a 44-year-old male who had renal dysfunction due to glomerulosclerosis with a decade-long history of steroid therapy. Although we started anti-tuberculosis treatment on clinical suspicion of miliary tuberculosis, cultures of sputum and bronchial lavage were both positive for M. xenopi. The patient was successfully treated with rifampin, ethambutol and clarithromycin, without fibrosis. It was unclear whether the miliary pattern was induced by hematogenous or endobronchial spread of the M. xenopi infection.


CONCLUSIONS
Even when clinical and radiological disease manifestations are similar to those of miliary tuberculosis, M. xenopi infection should be considered in the differential diagnosis of miliary nodules.
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Yoshio
Y
Okano
Department of Clinical Investigation, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan. shinoharat@kochi2.hosp.go.jp.
Tsutomu
T
Shinohara
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Shino
S
Imanishi
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Naoki
N
Takahashi
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Nobuhito
N
Naito
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Takanari
T
Taoka
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Naoki
N
Kadota
Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
Fumitaka
F
Ogushi
D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D017291:Clarithromycin / Q000627:therapeutic use; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D019912:Mycobacterium xenopi / Q000302:isolation & purification*; D012293:Rifampin / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
D004977:Ethambutol; D017291:Clarithromycin; D012293:Rifampin
Immunocompromised patient; Miliary nodules; Mycobacterium xenopi