A Novel Presentation of Mycobacterium Avium Complex in a Recipient of a Lung Transplant

A Case Report

Leah Cohen; Jeannette Guarner; William R. Hunt

Disclosures

J Med Case Reports. 2017;11(240) 

In This Article

Background

Lung transplantation remains an important therapeutic option for end-stage lung disease. It can improve quality of life and, in some cases, can be a life-lengthening therapy. As such, the number of lung transplants worldwide continues to increase steadily with 3973 performed in adults in 2014.[1] However, despite the desired benefits, lung transplantation is fraught with very serious potential complications. Early graft dysfunction, severe infections, and large airway complications such as development of exophytic granulation tissue and bronchial stenosis are common postoperatively.[2]

Depending on the center, the incidence of airway complications associated with lung transplantation ranges from 7 to 18% and results in a mortality rate of 2 to 4%.[3,4,5] Airway complications can directly result from architectural changes associated with surgical manipulation. However, preoperative and postoperative pulmonary infections also pose a significant risk factor for airway compromise.

The increased risk for airway infections can be contributed to pharmacological immunosuppression, airway devascularization, decreased cough reflex and mucociliarly clearance, disruption of lymphatic drainage, and altered alveolar phagocytic function following transplantation.[3] Common bacterial infections include Pseudomonas aeruginosa and Staphylococcus aureus, which usually present as tracheitis, bronchitis, or pneumonia.[2,6,7] Endobronchial anastomotic sites are particularly susceptible to post-transplant infections, especially in the early stage following surgery.[4]Aspergillus can commonly cause an endobronchial infection at the anastomotic site or tracheobronchitis. Some endobronchial infections can present as a tumor-like mass, including focal cytomegalovirus (CMV) infection and Mycobacterium tuberculosis (TB).[5] Infections with nontuberculous mycobacteria (NTM), such as Mycobacterium avium complex (MAC), are also relatively common following lung transplantation and have been associated with increased mortality.[8,9] Manifestations of NTM following lung transplantation have ranged from asymptomatic isolation to cutaneous symptoms to severe pulmonary parenchymal disease.[8,9,10] However, presentation of MAC as an endobronchial lesion is very rare and has not yet been described post lung transplantation.[11,12,13]

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