Unravelling the mystery of a rare infection: a challenging case of pulmonary sequestration with Mycobacterium avium complex and the importance of a thorough microbiological investigation.
Abdallah MughrabiJeffrey FennellyFelicitas FandreyerJorge FleisherPublished in: BMJ case reports (2023)
Pulmonary sequestration is a rare congenital condition. It is a dysplastic lung tissue with a separate systemic blood supply and without a bronchial tree connection. The emergence of a superimposed infection can lead to its diagnosis, such as Staphylococcus aureus, Pseudomonas aeruginosa, Nocardia asteroids and Aspergillus sp pneumonia. Mycobacterium avium complex (MAC) superimposed disease is exceedingly rare. We report a case of a man in his third decade without known medical disorders presenting with a persistent cough. After an extensive microbiological workup, an MAC infection was diagnosed. An elevated carbohydrate antigen 19-9 (CA 19-9) was also noted. He was treated with antimycobacterial therapy and lobectomy resulting in clinical improvement and CA19-9 normalisation. This case illustrates the value of comprehensive microbiological investigations in patients with chronic respiratory symptoms and imaging findings that are not typical of bacterial pneumonia. Clinical studies remain needed to investigate the utility of CA 19-9 in a scoring system to guide MAC therapy.
Keyphrases
- staphylococcus aureus
- pseudomonas aeruginosa
- mycobacterium tuberculosis
- pulmonary hypertension
- healthcare
- high resolution
- cystic fibrosis
- biofilm formation
- bone marrow
- mass spectrometry
- case report
- photodynamic therapy
- methicillin resistant staphylococcus aureus
- extracorporeal membrane oxygenation
- respiratory failure
- multidrug resistant
- respiratory tract
- thoracic surgery