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Case Reports
. 2013 Nov 19:2013:bcr2013200776.
doi: 10.1136/bcr-2013-200776.

Endobronchial avium mycobacteria infection in an immunocompetent child

Caroline Perisson  1 , Nadia Nathan, Briac Thierry, Harriet Corvol
Affiliations
Case Reports

Endobronchial avium mycobacteria infection in an immunocompetent child

Caroline Perisson et al. BMJ Case Rep. .

Abstract

A 12-month-old boy, with no medical history, was admitted for dyspnoea with no cough or fever. Chest auscultation revealed an expiratory wheezing with decreased right-sided breath sounds. Chest imaging revealed subcarinal adenopathy and a nodule in the right principal bronchus (RB). Bronchoscopy showed a major obstruction of the RB by a granuloma, and a smaller granuloma in the left principal bronchus. The granulation tissue was removed by laser section. Histological examination revealed a necrotising granulomatous inflammation, culture showed a Mycobacterium avium complex (MAC). Tests to rule out tuberculosis and immunodeficiency were negative. The diagnosis of an MAC endobronchial granuloma was ascertained and a multidrug therapy associating clarithromycin, rifampin and ethambutol was started. The clinical outcome was good after 3 months of treatment and the bronchoscopy normalised after 1 year. Although rare, the frequency of MAC respiratory infections in immunocompetent children can increase. Reporting these cases should help to optimise diagnosis and treatment.

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Figures

Figure1
Figure1
(A) Chest X-ray showing a dissymmetric transparency with right air trapping and hilar lymphadenopathy at admission. (B) Lung CT scan revealing large subcarinal lymphadenopathy constricting the two principal bronchi, as well as a nodule in the right principal bronchus at admission.
Figure 2
Figure 2
Second bronchoscopy after 15 days of treatment.
Figure 3
Figure 3
The chest X-ray was normal after 3 months of triantibiotherapy against Mycobacterium avium complex.
See this image and copyright information in PMC

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