Bronchial stenosis associated with non‐tuberculous mycobacterial infection

Abstract

A previously healthy 9-month-old girl presented with dyspnea and wheezing that progressed for a week. There was no significant medical or family history of severe infections. The living environment around the patient was hygienic and there were no prevalent infections. Physical findings revealed only wheezing and no cervical lymphadenopathy or hepatosplenomegaly. Although the patient's respiratory rate was 30-40 breaths/min with SpO 2 97%, she required oxygen temporarily because of a leftright difference in breathing. Immunochromatography tests for respiratory syncytial virus and human metapneumovirus from nasal swabs were negative. The poor response to initial treatment with an aerosolized bronchodilator and oral corticosteroid led physicians to suspect diseases other than bronchial asthma. Chest X-ray demonstrated atelectasis in the right upper lobe with hyperinflation of the right, middle, and lower lobes, and a mediastinal shift to the left, suggesting foreign body aspiration (Fig. 1). Computed tomography and bronchoscopy revealed bronchial stenosis from endobronchial masses in the left main bronchus and right bronchus intermedius, and subcarinal and paratracheal lymphadenopathy, suggesting a possible bronchial endothelial tumor, lymphoma, sarcoidosis, and lymphadenitis (Fig. 2). Histopathological examination of a paratracheal lymph node collected by open chest biopsy revealed granulomas. Although initial polymerase chain reaction testing of the lymph node for Mycobacterium was negative, M. avium subsp. hominissuis was identified in cultures of sputum collected by bronchoscopy and the lymph node at 4 weeks, finally resulting in a diagnosis of non-tuberculous mycobacterial (NTM) infection. 1 Systemic examinations, including gallium scintigraphy, head magnetic resonance imaging, and ophthalmological examination revealed no lesions other than subcarinal and mediastinal lymphadenopathies. In the peripheral blood examination, white blood cells (including neutrophils and lymphocytes), red blood cells, C-reactive protein, IgG, IgA, IgM, and