Volume 3, Number 4; July 16, 2004
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Volume 3, Number 4; July 16, 2004 |
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Older smoker with recent weight loss
Recommended reading:
(Dr. Bedi)
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Resident Report 7/16/04 — Samer Bedi
Case: 63 yo male with AIDS (CD 4 or 38) referred to GMH for biopsy of right lung mass found on CXR. Pt states he has been feeling well except for weight loss of 10lbs in 2 months despite good appetite. He denies fevers, chills, night sweats, cough, or chest pain. He is taking Combivir and Kaletra as prescribed but is taking no other medicines. Patient admits to a 25 pack-year history of smoking. He has a history of MAC in his sputum from one year ago.
On initial presentation, patient is afebrile, his lungs are clear to auscultation bilaterally, there is no clubbing, or cyanosis. CXR reveals a spiculated right middle lobe mass 3.5 x 2.2 cm with flattened hemi-diaphragms. CT guided biopsy of the RML mass is negative for malignant cells, is AFB smear-positive and culture-positive for MAC. AFB blood culture is negative.
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Clinical Question: What are the criteria for active Pulmonary MAC?
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Readings:
Link Directly to Fulltext Article at Publisher <1> Unique Identifier:12884187 Authors: Salama C. Policar M. Venkataraman M. Institution: Division of Infectious Diseases, Elmhurst Hospital Center, Elmhurst, NY 11373, USA. csalama@yahoo.com Title: Isolated pulmonary Mycobacterium avium complex infection in patients with human immunodeficiency virus infection: case reports and literature review. [Review] [18 refs]
Source: Clinical Infectious Diseases. 37(3):e35-40, 2003 Aug 1. Abstract: We report 4 cases of isolated pulmonary Mycobacterium avium complex (MAC) infection and review the 20 previously reported cases in the human immunodeficiency virus literature. All 4 patients had acquired immune deficiency syndrome, and 3 were believed to have had an immune reconstitution syndrome as a cause of MAC infection. Two patients underwent bronchoscopy with biopsy, revealing endobronchial lesions and granuloma formation, and all 4 patients responded well to MAC therapy. [References: 18]
Link Directly to Fulltext Article at Publisher <2> Unique Identifier:9279284 Authors: Anonymous. Title: Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. [Review] [218 refs]
Source: American Journal of Respiratory & Critical Care Medicine. 156(2 Pt 2):S1-25, 1997 Aug. Abstract: Diagnostic criteria of nontuberculous mycobacterial lung disease in HIV-seropositive and -seronegative hosts. The following criteria apply to symptomatic patients with infiltrate, nodular or cavitary disease, or a high resolution computed tomography scan that shows multifocal bronchiectasis and/or multiple small nodules. A. If three sputum/bronchial wash results are available from the previous 12 mo: 1. three positive cultures with negative AFB smear results or 2. two positive cultures and one positive AFB smear B. If only one bronchial wash is available: 1. positive culture with a 2+, 3+, or 4+ AFB smear or 2+, 3+, or 4+ growth on solid media C. If sputum/bronchial wash evaluations are nondiagnostic or another disease cannot be excluded: 1. transbronchial or lung biopsy yielding a NTM or 2. biopsy showing mycobacterial histopathologic features (granulomatous inflammation and/or AFB) and one or more sputums or bronchial washings are positive for an NTM even in low numbers. Comments: these criteria fit best with M. avium complex, M. abscessus, and M. kansasii. Too little is known of other NTM to be certain how applicable these criteria will be. At least three respiratory samples should be evaluated from each patient. Other reasonable causes for the disease should be excluded. Expert consultation should be sought when diagnostic difficulties are encountered. [References: 218]
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2004 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Monica Adams MD / Josh Larned MD
Contact:
Karl Woodworth
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