Presentation
Progressive weakness and loss of appetite.
Patient Data
Multiple irregular thick-walled cavities in the left upper lobe and superior segment of the left lower lobe.
Bronchiectatic airways in the affected areas with some areas of distal airway impaction.
Minimal left apical pneumothorax.
Bronchoalveolar lavage AFB:
Multiple acid fast bacillus seen by fluorochrome stain.
Mycobacterium xenopi isolated by MALDI-TOF mass spectrometry analysis.
Case Discussion
This patient had bronchoscopy and bronchoalveolar lavage on admission with numerous AFB on smear and Mycobacterium xenopi was isolated. Quantiferon indeterminate. Mycobacterium tuberculosis PCR negative; TB culture eventually negative as well.
Treatment generally involves rifampicin, ethambutol, and either a macrolide and/or a fluoroquinolone for at least 12 months.
Case authors: Taner B. Celebi D.O. and Hadi Dahhan D.O.
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