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Case Reports: Reminder of important clinical lesson
Cavitating pulmonary lung lesions with more than one microbiological aetiology
  1. Maria Bisgaard Borup1,
  2. Casper Falster1,2,
  3. Niels Jacobsen1,2 and
  4. Jesper Rømhild Davidsen1,2
  1. 1Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
  2. 2Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Dr Maria Bisgaard Borup; maria.bisgaard.borup{at}rsyd.dk

Abstract

Non-tuberculous mycobacteria (NTM) are one of the predominant microbes observed in immunocompromised patients with structural lung disease. Especially in immunocompromised patients, the treating physician needs to be aware of concurrent lung infections with opportunistic pathogens. In this case report we present a man in his 60s with severe chronic obstructive pulmonary disease (COPD) and bullous emphysema, who was diagnosed with Mycobacterium europaeum but with persistent clinical deterioration despite relevant treatment for NTM. A subsequent bronchoalveolar lavage (BAL) revealed elevated Aspergillus galactomannan antigen which, when seen in relation to imaging-findings of cavitating opacities with aggravating surrounding consolidation, raised suspicion of concurrent subacute invasive aspergillosis. Antifungal treatment was initiated but due to intolerable side effects was discontinued after only a few weeks. This case highlights the importance of concurrent testing for pulmonary aspergillosis in NTM patients and vice versa before treatment initiation and if the disease and symptoms are progressing despite relevant treatment.

  • TB and other respiratory infections
  • radiology
  • respiratory medicine
  • infectious diseases

https://doi.org/10.1136/bcr-2021-247396

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    Footnotes

    • Contributors MBB made the first manuscript draft. CF, NJ and JRD made critical revision to the manuscript for important intellectual consent. CF and NJ made figures 1 and 2. All authors have approved the final version. JRD is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.