Mycobacterium avium lung disease combined with a bronchogenic cyst in an immunocompetent young adult

Abstract

We report a very rare case of a bronchogenic cyst combined with nontuberculous mycobacterial pulmonary disease in an immunocompetent patient. A 21-year-old male was referred to our institution because of a cough, fever, and worsening of abnormalities on his chest radiograph, despite anti-tuberculosis treatment. Computed tomography of the chest showed a large multi-cystic mass over the right-upper lobe. Pathological examination of the excised lobe showed a bronchogenic cyst combined with a destructive cavitary lesion with granulomatous inflammation. Microbiological culture of sputum and lung tissue yielded Mycobacterium avium. The patient was administered anti-mycobacterial treatment that included clarithromycin.

Keywords: Bronchogenic cyst; Mycobacterium avium complex; Nontuberculous mycobacteria.

Figure 1

A 21-year-old man with Mycobacterium avium infection combined with a bronchogenic cyst. (A) Chest radiography showed a cystic mass in the right upper lobe. (B) After anti-tuberculosis medication for 6 months, the mass increased in size and developed multiple cavities.

Figure 2

A 21-year-old man with Mycobacterium avium infection combined with a bronchogenic cyst. (A) Chest computed tomography (CT) revealed a multi-loculated cystic mass with bronchiolitis in the right upper lobe. (B) The resected right upper lobe showed an intrapulmonary bronchogenic cyst in the apical segment (arrow) and multiple cavitary necroses in the destroyed apical segment of the right upper lobe (arrowhead). (C) Microscopic findings of the multiple cavitary lesions revealed chronic granulomatous inflammation (the lesion is indicated by an arrowhead on the chest CT and gross findings) (H&E, × 100). (D) The microscopic findings of the bronchogenic cyst showed that the cyst was walled by ciliated columnar epithelium (the lesion is indicated by an arrow on chest CT and gross findings) (H&E, × 40).