Disseminated Mycobacterium Avium Complex Disease in an Immunocompetent Patient: A Case Report

免疫功能正常的病人感染瀰漫性鳥型分枝桿菌疾病：一病例報告

湯硯翔(Yen-Hsiang Tang) ； 林榮祿(Rong-Luh Lin) ； 吳健樑(Chien-Liang Wu)

《胸腔醫學》 30卷2期 (2015/04) Pp. 79-85

摘要

彌漫性鳥型分枝桿菌感染罕見於免疫功能正常的病人。除了肺臟之外，最常見的肺外感染病灶是骨頭及關節。我們報導一位80歲女性，在兩星期前開始有左側腰痛以及雙側小腿無力的症狀。此病人多年前即頻繁的在痰液培養出鳥型分枝桿菌。胸部X光片顯示在雙肺野多發性的實質化病灶。脊椎核磁共振照影顯示第七節胸椎至第九節胸椎的椎體，在T1-FLAIR影像上是低顯影，而在STIR影像上則是高顯影。起初我們判斷這些病灶是惡性腫瘤造成的，因此施行第八節胸椎腫塊切除手術。病理報告顯示肉芽腫性發炎反應，組織則培養出鳥型分枝桿菌。病人同時併有腸阻塞，腹水，腹瀉且糞便也培養出鳥型分枝桿菌。我們給予clarithromycin，rifampin，以及ethambutol治療。四個月後追蹤的胸部X光顯示之前的實質化病灶消散許多。追蹤的脊椎Ｘ光片則顯示高度縮減的第八節胸椎與金屬板固定。在接受復健後，此病人可以靠著輔具自行行走。而且她的腹瀉亦停止了。

關鍵字

彌漫性鳥型分枝桿菌 ； 免疫功能正常

並列摘要

Disseminated Mycobacterium avium complex (MAC) infection rarely occurs in immunocompetent individuals. Besides pulmonary infection, the most common extrapulmonary sites of MAC infection are the bones and joints. We presented an 80-year-old woman who complained of left flank pain and bilateral lower legs weakness for 2 weeks. Her previous history included the finding of frequent MAC colonization in sputum culture for years. CXR revealed multifocal consolidation in bilateral lung fields. The spinal MRI showed signal change involving the vertebral bodies from T7 to T9 presenting as hypointense on T1-FLAIR, and hyperintense on STIR sequence with strong enhancement. We initially considered the lesion as malignancy and a T8 spinal tumor was resected. The pathology disclosed granulomatous inflammation, and the tissue culture grew MAC. The patient's ileus, ascites, diarrhea and stool culture also grew MAC. Clarithromycin, rifampicin, and ethambutol were prescribed. Follow-up CXR 4 months later showed much resolution of the consolidation. Follow-up spinal X-ray revealed decreased T8 height with metallic device fixation. The patient could walk around with a walker after rehabilitation. Her diarrhea also resolved.

並列關鍵字

Disseminated mycobacterium avium complex ； immunocompetent