A tale of two images: From mycobacterium avium complex-lung disease (MAC-LD) to mycobacterium avium complex-pleural disease

• Main Authors: Mary Rithu Varkey, Tania M. Kohal, Amit Barua, Nicole C. Lapinel, Juzar Ali
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: Respiratory Medicine Case Reports
• Subjects: Mycobacterium avium complex-lung disease; MAC-Pleural disease; Macrolide resistance MAC; Broncho pleural fistula
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213007121000721

The typical radiographic presentation for Mycobacterium avium complex lung disease (MAC-LD) is either nodular bronchiectasis or cavitary lung disease. The former is seen most commonly in middle-aged or elderly Caucasian females with the characteristic asthenic phenotype, and the latter in middle-aged male smokers with COPD. We present the case of a young, otherwise healthy woman, with no significant risk factors, who was incidentally found to have MAC-LD with associated bronchiectasis. The patient's treatment and clinical course over a period of 5 years was marred by erratic follow up, intermittent treatment and poor adherence to guideline-based antibiotic therapy. Over this period of time, the patient developed significant worsening of her MAC-LD, macrolide resistance and failure to thrive. Upon presentation 5 years after her initial diagnosis, she had developed MAC-Pleural Disease with an empyema and broncho-pleural fistula. This case illustrates the progression of MAC-LD from nodular bronchiectasis to cavitary disease and pleural involvement leading to clinical deterioration. It highlights challenges related to short and long term management of macrolide resistant MAC-LD and the importance and need for surgical intervention and drainage procedures in patient with MAC-Pleural Disease.