A 46-year-old man was transferred to our hospital due to an unexpandable lung after a closed thoracostomy for his spontaneous pneumothorax (Fig. 1A and B). It had occurred 4 days before the visit of the other hospital. He had a history of recurrent pneumonia. He had a gout without receiving corticosteroid therapy and was a 30 pack-year current smoker. His chest computed tomography (CT) scans showed a cavitary consolidation in the left upper lobe and micronodules in the right upper lobe (Fig. 1C). His left lung showed structural changes including emphysema and hypoplasia (Fig. 1C). Incidentally, left pulmonary artery agenesis was noticed in his CT scans (Fig. 1D). We inserted an additional chest tube. We did acid fast bacilli stains (AFB), mycobacterial cultures, and M. tuberculosis PCR test in his sputa and pleural fluid. We also did a bronchoscopy test for further evaluation of TB due to negative results of AFB stain and Mycobacterium tuberculosis PCR test in his sputa and pleural fluid. His bronchoscopic specimens also showed negative results of AFB stain and M. tuberculosis PCR test. We removed his chest tubes after confirmation of fully expended his left lung on a chest radiography. He discharged from our hospital.
One month after his discharge, he revisited to our emergency department due to dyspnea. We found out a recurrent pneumothorax in his left lung and inserted a chest tube. NTM was isolated from all mycobacterial cultures in his sputa, bronchoscopic specimen, and pleural fluid, and M. intracellulare was identified from all positive NTM cultures. We started azithromycin (250 mg/day), rifampin (600mg/day), and ethambutol (800mg/day), and amikacin (1g intravenous tree times per week) for treating his M. intracellulare pulmonary disease and pleural infection. His lung was expanded well after a closed thoracostomy and discharged after chest tube removal.
We achieved a culture conversion after 4 months of treatment initiation. We stopped the intravenous amikacin after 6 months due to a development of hearing loss. We maintained the regimen for 16 months, and culture conversion maintained at the end of treatment. There was no recurrence at 6 months after treatment completion.