Early Pulmonary Resection for Mycobacterium Avium Complex Lung Disease Treated With Macrolides and Quinolones

Lady Windermere revisited: treatment with thoracoscopic lobectomy/segmentectomy for right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial disease☆

“…The limitations of medical treatment can perpetuate a cycle of symptomatic disease recurrence and progressive parenchymal tissue damage. The spectrum of damage to the lung ranges from focal bronchiectasis or cavitary disease, to a completely destroyed lung [2,4,[7][8][9][10][11].…”

Lady Windermere syndrome

“…91,92 Two surgical studies using lobectomy and segmentectomy for isolated disease or disease not responding to several months of antibiotics showed that 92%-100% of patients underwent sputum conversion after surgery. 28,34 There was no operative mortality in these studies. Thus, surgery appears to be a relatively safe option for patients failing antibiotic therapy who have sufficient cardiopulmonary reserve.…”

Pulmonary Resection for Mycobacterium Chelonae Infection

“…According to several reports of the recurrence rate of nontuberculous mycobacterial infection after surgery, the sputum negative conversion rate was high, at 82%-94%. 10,[19][20][21] It is commonly believed that the treatment duration includes 12 months of sputum culture negativity while on therapy, 22) and, in the present case, the patient continued to receive oral antibiotic therapy after surgery, and has been followed up carefully. Regarding surgery for M. chelonae, much is unknown, including the long-term prognosis and chemotherapy to prevent recurrence.…”

“…[8][9][10] Since surgical treatment for the M. avium complex infection is generally effective in controlling infection, therefore, it is likely that surgical treatment for M. chelonae infection is also effective. 10,12,[19][20][21] Surgery may be useful in the following settings: i) patients with localized disease, ii) patients, in whom medical therapy is ineffective, and iii) patients who cannot tolerate medical therapy. 2,12) Pulmonary resection should be considered before the expansion of lesions in patients in whom complete resection is considered possible based on the number and extent of lesions.…”