Pulmonary Mycobacterium avium complex infection

Case contributed by Bruno Di Muzio
Diagnosis certain


Chronic cough and shortness of breath.

Patient Data

Age: 70 years
Gender: Female

Multiple cavitating lesions within the right lower and middle lobes. Bilateral extensive varicose and traction bronchiectasis with a right middle and lower lobe predominance. Bilateral tree in bud appearance with lower lobe predominance along with multiple small pulmonary nodules.

Pleural scarring and nodularity are likely due to chronic infection.

No pleural effusions.

Prominent but sub centimeter mediastinal lymph nodes.

Sputum sample: 
Acid-fast bacilli detected. 

  • ANTIGEN TESTING: MPT64 Antigen Identification Test: M.tuberculosis Complex NOT detected.
  • NUCLEIC ACID TESTING:  M.tuberculosis Complex PCR by GeneXpert: NOT Detected.


Case Discussion

This case illustrates advanced changes of MAC in a patient that has been on treatment for a few years, on what difficult response was observed and was multiple relapses of symptoms. 

Bronchiectasis with associated centrilobular nodules is the dominant feature, which unlike pulmonary tuberculosis does not have a predilection for the upper lobes.

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