No abstract

The incidence of pulmonary nontuberculous mycobacterial (NTM) infection is increasing worldwide, and its clinical outcomes with current chemotherapies are unsatisfactory. The incidence of tuberculosis (TB) is still high in Africa, and the existence of drug-resistant tuberculosis is also an important issue for treatment. To discover and develop new efficacious anti-mycobacterial treatments, it is important to understand the host-defense mechanisms against mycobacterial infection. Nuclear erythroid 2 p45-related factor-2 (NRF2) is known to be a major regulator of various antioxidant response element (ARE)-driven cytoprotective gene expressions, and its protective role has been demonstrated in infections. However, there are not many papers or reviews regarding the role of NRF2 in mycobacterial infectious disease. Therefore, this review focuses on the role of NRF2 in the pathogenesis of Mycobacterium tuberculosis and Mycobacterium avium infection.

Antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis (AAV) caused by methimazole (MMI) is known to be relatively rare; therefore, the optimal therapeutic approach for these cases remains to be established. A 59‐year‐old man who was treated with MMI for a diagnosis of Graves’ disease was referred to our hospital because of progressive haemoptysis. The patient was diagnosed with diffuse alveolar haemorrhage (DAH) secondary to AAV based on increased inflammatory reactions with positive myeloperoxidase‐ANCA in the serum and the results of bronchoalveolar lavage fluid. MMI was suspected as the cause of the AAV; therefore, the administration of MMI was discontinued. Thereafter, the patient’s symptoms as well as chest radiographic abnormalities completely resolved, in conjunction with normalization of the serum ANCA level. Our experience with this case suggests that DAH secondary to AAV caused by MMI may improve with discontinuation of the offending drug alone, with no other treatment.