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We present a 19-year-old woman, a case of Lemierre syndrome, who presented with fever, sore throat, and left shoulder pain. Imaging revealed a thrombus in the right internal jugular vein, multiple nodular shadows below both pleura with some cavitations, right lung necrotizing pneumonia, pyothorax, abscess in the infraspinatus muscle, and multiloculated fluid collections in the left hip joint. After inserting a chest tube and administering urokinase for the pyothorax, a bronchopleural fistula was suspected. The fistula was identified based on clinical symptoms and computed tomography scan findings. If a bronchopleural fistula is present, thoracic lavage should not be performed as it may cause complications such as contralateral pneumonia due to reflux.

Background and ObjectivesThe number of patients with pulmonary Mycobacterium avium complex (MAC) disease is increasing worldwide, especially among middle-aged women and never-smokers. Although sex and smoking status have attracted attention as predictors in the development and exacerbation of pulmonary MAC disease, the exact associations remain unknown.The aim of the present study was to clarify the associations of sex and smoking status with the clinical characteristics of pulmonary MAC disease and to identify the predictors of exacerbations of pulmonary MAC disease. MethodsThe subjects were 128 patients diagnosed with pulmonary MAC disease according to the 2007 American Thoracic Society/Infectious Disease Society guidelines from May 2011 to May 2016 at our institute. Their medical records were retrospectively examined for their clinical findings. The radiological findings at the time of the diagnosis and 1 year later were evaluated. Clinical characteristics were compared by smoking status and sex. To identify the natural predictors of exacerbation, multivariable analysis was performed with the data of 80 treatment-naïve patients. ResultsFemale, never-smoker, and nodular/bronchiectatic (NB) type were common in patients with pulmonary MAC disease. Univariate analysis of data from treatment-naïve subjects showed that female, never-smoker, fewer lung diseases other than MAC, extensive radiological findings, and ≥3 lobes involved were significantly associated with exacerbations. On multivariate analysis, fewer lung diseases other than MAC, extensive radiological findings, and ≥3 lobes involved were significantly associated with exacerbations, but female and never-smoker were not. ConclusionsIn this study, extensive radiological findings, especially abnormal shadows in ≥3 lobes and absence of lung diseases other than MAC, rather than sex and smoking status, were predictors of exacerbations of treatment-naïve pulmonary MAC disease.