Rapidly Growing Mycobacterial Lung Infection in Association With Esophageal Disorders

doi:10.4065/74.1.45

Mayo Clinic Proceedings

Volume 74, Issue 1, January 1999, Pages 45-51

https://doi.org/10.4065/74.1.45 Get rights and content

Esophageal or other swallowing disorders complicated by lipoid pneumonia are reported to be associated with pulmonary infections caused by rapidly growing mycobacteria.⁴ Herein we describe a 63-year-old woman with achalasia of the esophagus complicated by lung infection with Mycobacterium chelonae and a 47-year-old man in whom long-term ingestion of mineral oil was complicated by lipoid pneumonia and M. fortuitum lung infection. A MEDLINE search of English language publications from 1966 to 1997 revealed 18 cases of lung infections caused by rapidly growing mycobacteria in patients with esophageal disorders. Of these 18 patients and our 2 patients, 11 were men and 9 were women (mean age, 50 years). Achalasia was present in 11 patients, and 6 had lipoid pneumonia without evidence of esophageal disorders. Three patients had lipoid pneumonia caused by lipoid ingestion in the setting of achalasia or another swallowing disorder. In 14 patients, lung infection was caused by M. fortuitum; in 5, M. chelonae; and in 1, a non-M. Jortuitum rapidly growing mycobacterial infection. The most common clinical feature was fever, and the most common roentgenologic abnormality was the presence of unilateral or bilateral and patchy or dense infiltrates. The sputum was the most common source of isolation of rapidly growing mycobacteria. Achalasia and lipoid pneumonia are important risk factors for the development of lung infections caused by rapidly growing mycobacteria. Treatment of the esophageal disease might prevent occurrence of and facilitate recovery from these infections.

Section snippets

Case 1

A 63-year-old woman with achalasia of the esophagus, previously treated with colonic interposition, was admitted to our institution because of fever, dyspnea, anorexia, and bilateral pulmonary infiltrates. Previously, she had been examined and treated at another hospital with intravenous and oral antibiotic therapy, without pronounced response. Past medical history included treated tuberculosis infection, left upper lobectomy for resection of a tuberculous granuloma, hypertension, type 2

Review Of The Literature

We performed a MEDLINE search of English language publications since 1966 to identify reports of pulmonary infections due to rapidly growing mycobacteria The search strategy included reports of patients with swallowing disorders or lipoid pneumonia (or both) and proven pulmonary infection with rapidly growing mycobacteria We included patients in whom repeated sputum cultures (at least three) showed rapidly growing mycobacteria and evidence of lung disease based on clinical symptoms, signs,

Discussion

Eighteen previously reported cases and our two cases fulfilled the aforementioned criteria.2, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 The clinical characteristics are listed in Table 1. The mean age of the 11 men and 9 women was 50 years, and the range was 29 to 75 years (age was not known for 1 patient). Achalasia was the most common esophageal disorder and was present in 11 patients (55%). Six patients (30%) had no pronounced esophageal or swallowing disorder, but they had

Conclusion

In patients with prolonged or refractory lung infection (or both) in the presence of deglutition problems, atypical mycobacteria should be suspected. The most common findings are pulmonary infiltrates on chest roentgenograms and fever. Patients are usually middle-aged, and no sex or smoking status predilection is evident. Underlying lung disease and other chronic conditions are uncommon. M. fortuitum seems to be the most common pathogen. Concomitant therapy for the esophageal disease and

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Nontuberculous Mycobacterial Infections
2022, Radiologic Clinics of North America
Citation Excerpt :
Rapidly growing mycobacterial species such as M fortuitum and M chelonae have been isolated in infections in patients with esophageal dysfunction, such as from achalasia, hiatal hernia, stroke, and prior esophagectomy. Chronic aspiration is most likely the mechanism of infection and may be complicated by lipoid pneumonia.20,42 Chest radiograph and CT show unilateral or bilateral patchy nodular or consolidative opacities resembling aspiration.6
Nontuberculous Mycobacterial Pulmonary Disease: A Clinical and Radiologic Update
2022, Seminars in Roentgenology
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasingly recognized in the U.S. and worldwide as a debilitating disease that is challenging to diagnose and manage. Beyond the principle task of recognizing the protean imaging manifestations of NTM-PD, radiologists will need to appropriately communicate with pulmonology and infectious disease colleagues in multidisciplinary management discussions. This update on nontuberculous mycobacteria (NTM) species, their clinical significance, and imaging features aims to support these roles. Terminology mirrors that laid out by the American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) published guidelines on NTM-PD.¹
Mycobacterium avium complex infection in a patient with systemic sclerosis- associated interstitial lung disease: A case report
2020, Respiratory Medicine Case Reports
We describe a case of a 65-year-old male with recently diagnosed diffuse cutaneous systemic sclerosis associated with usual interstitial pneumonia and pulmonary hypertension. Patient presented to the emergency department complaining of low-grade fever, increased sputum production, progressive dyspnea and weight loss. High-resolution computed tomography scan showed multifocal bronchiectasis with multiple small nodules. Bronchoalveolar lavage culture was positive for Mycobacterium intracellulare. Antimicrobial treatment was started which improved respiratory symptoms. One month after the initiation of antibiotics, cyclophosphamide therapy was started with adequate tolerance.
A 65-Year-Old Man with Pulmonary Opacities and Worsening Cough
2019, Chest
A 65-year-old man was referred for evaluation of several years of chest congestion and cough productive of yellow sputum as well as recently noted abnormalities on chest imaging. He denied dyspnea, weight loss, fevers, chills, or hemoptysis. He had no history of systemic illness, pneumonia, other respiratory illness, gastroesophageal reflux, or sinusitis. He had a remote smoking history. He worked as a railroad conductor and had occupational exposure to asbestos, as well as to other uncharacterized dusts and fumes. The patient spent most of his life in Washington and California and regularly traveled through the California Central Valley. Other travel history included trips to Southeast Asia, Iceland, and Europe in the remote past. The patient had one dog but no exposure to other animals. His only medication was loratadine, taken daily for allergic rhinitis. He applied petroleum jelly to his nares nightly to moisturize his nasal passages.
Mycobacterium goodii pneumonia: An unusual presentation of nontuberculous mycobacterial infection requiring a novel multidisciplinary approach to management
2019, Respiratory Medicine Case Reports
Mycobacterium goodii is a rapidly growing nontuberculous mycobacterium which has been associated with several infections including cellulitis, osteomyelitis, lymphadenitis, infected pacemakers and bursitis but it is a rare cause of respiratory infection.
In this case report we describe a 51-year-old woman who presented with a 6-week history of non-productive cough, pleuritic chest pain and weight loss. She had a history of gastric adenocarcinoma managed with a distal oesophagectomy and total gastrectomy and consequentially suffered severe post-operative gastric reflux. Initial cultures were negative but following a VATS lung biopsy Mycobacterium goodii was cultured and histology revealed an organising pneumonia. Treatment was with a prolonged course of steroids, amikacin and meropenem followed by oral ciprofloxacin and doxycycline. Ongoing gastric dysmotility and weight loss showed clinical improvement with a novel approach of a combination of prokinetics and somatostatin analogues controlling risk of repeat aspiration and improving symptom control.
This is an unusual case of organising pneumonia related to Mycobacterium goodii infection and highlights the importance of mycobacterial culture in unusual and unresolving cases of organising pneumonia. The importance of controlling symptoms related to gastric dysmotility and aspiration is also addressed.
Mycobacterium fortuitum empyema associated with an indwelling pleural catheter: Case report and review of the literature
2017, Journal of Infection and Chemotherapy
Citation Excerpt :
Of note, the isolate in this case was resistant to imipenem despite prior reports of 100% susceptibility [13]. American Thoracic Society guidelines recommend treatment regimens for pulmonary infections with at least two agents for at least 12 months past negative repeat sputum cultures [9]. Our patient was discharged on ciprofloxacin and clarithromycin prior to the availability of susceptibilities [15].
Mycobacterium fortuitum is a rapidly growing mycobacterium (RGM) that is an uncommon cause of healthcare-associated infections. The most common infections caused by M. fortuitum include skin, soft tissue, and catheter-related infections. Although occasionally cultured from sputum samples, M. fortuitum is a rare cause of pulmonary disease. We report a case of M. fortuitum empyema associated with an infected pleural catheter and review M. fortuitum pulmonary infections.

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^*: Current address: Duke University Medical Center, Durham, North Carolina.

^†: Current address: Carolina Respiratory Specialists, Charlotte, North Carolina.

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Mayo Clinic Proceedings

Section snippets

Case 1

Review Of The Literature

Discussion

Conclusion

References (25)

infection caused by nontuberculous mycobacteria: clinical aspects

Semin Roentgenol

Pulmonary infections with atypical mycobacteria in the normal host

Semin Roentgenol

Treatment of infections caused by rapidly growing mycobacteria in trie era of the newer macrolides

Res Microbiol

Clinical conference in pulmonary disease: aspiration and occult esophageal disorders

Chest

Nontuberculous mycobactena in pleural fluid: assessment of clinical significance

Chest

Achalasia, aspiration, and atypical mycobacteria

Mayo Clin

Pulmonary Mycobacterium fortuitum infection in association with achalasia of the oesophagus: case report and review of the literature

Br J Dis Chest

Diagnosis and treatment of disease caused by nontuberculous mycobacteria

Am J Respir Crit Care Med

Spectrum of disease due to rapidly growing mycobacteria

Rev Infect Dis

Pulmonary disease due to rapidly growing mycobacteria

Semin Respir Med

Clinical features and treatment of infection due to Mycobacterium fortuitum/chelonae complex

Curr Clin Top Infect Dis

Pulmonary manifestations of nontuberculous Mycobacterium

Radial Clin North Am

Cited by (80)

Nontuberculous Mycobacterial Infections

Nontuberculous Mycobacterial Pulmonary Disease: A Clinical and Radiologic Update

Mycobacterium avium complex infection in a patient with systemic sclerosis- associated interstitial lung disease: A case report

A 65-Year-Old Man with Pulmonary Opacities and Worsening Cough

Mycobacterium goodii pneumonia: An unusual presentation of nontuberculous mycobacterial infection requiring a novel multidisciplinary approach to management

Mycobacterium fortuitum empyema associated with an indwelling pleural catheter: Case report and review of the literature

Subspecialty Clinics: Pulmonary and Critical Care MedicineRapidly Growing Mycobacterial Lung Infection in Association With Esophageal Disorders

Section snippets

Case 1

Review Of The Literature

Discussion

Conclusion

Semin Roentgenol

Semin Roentgenol

Res Microbiol

Chest

Chest

Mayo Clin

Br J Dis Chest

Diagnosis and treatment of disease caused by nontuberculous mycobacteria

Am J Respir Crit Care Med

Spectrum of disease due to rapidly growing mycobacteria

Rev Infect Dis

Pulmonary disease due to rapidly growing mycobacteria

Semin Respir Med

Clinical features and treatment of infection due to Mycobacterium fortuitum/chelonae complex

Curr Clin Top Infect Dis

Pulmonary manifestations of nontuberculous Mycobacterium

Radial Clin North Am

Subspecialty Clinics: Pulmonary and Critical Care Medicine
Rapidly Growing Mycobacterial Lung Infection in Association With Esophageal Disorders