A case of co-existent disseminated Mycobacterium avium infection and non-Hodgkin's lymphoma
Ryoko Sawamoto1) Dai Hidaka1) Junichiro Hiyama1) Akiko Fujii2) Yukihiro Misumi2) Yousuke Miyagawa2) Shinji Tomimitsu3) Akihiro Hayashi3) Ken Ono4) Fumitou Arima5) Kouji Irie6) Kiyofumi Ohkusu7)
1)Department of Pulmonary Medicine, Shin-Koga Hospital, Tenjin-kai 2)Department of Pulmonary Medicine, Koga Hospital 21,Tenjin-kai 3)Department of Thoracic Surgery, Shin-Koga Hospital, Tenjin-kai 4)Department of Radiology, Shin-Koga Hospital, Tenjin-kai 5)Department of Hematology, Koga Hospital 21, Tenjin-kai 6)Department of Pathology, Shin-Koga Hospital, Tenjin-kai 7)Department of Microbiology, Gifu University Graduate School of Medicine
A 76-year-old man was admitted to our hospital with dyspnea. Chest CT revealed bronchial stenosis caused by mediastinal lymphadenopathy. An FDG-PET scan showed increased FDG uptake in the mediastinal lymph nodes, lumbar vertebrae and left ilium. Neither the first biopsy specimen from the left ilium nor the endobronchial lesion showed malignant cells, but both were positive on acid-fast bacillus staining. Genetic testing found the Mycobacterium avium (MAC) gene. Therefore, we diagnosed disseminated MAC infection, and started antibiotic therapy. However, he did not respond to the therapy, and his bronchial stenosis worsened. We performed a biopsy of the newly-appearing supraclavicular lymph node, and of the left ilium again, and confirmed a new diagnosis; diffuse large B cell lymphoma, coexistent with disseminated MAC infection. This case suggests not only the simultaneous occurrence of disseminated MAC infection and diffuse large B cell lymphoma, but also the coexistence of both diseases within the same organs, and that there may be some relationship between the two diseases.
Disseminated Mycobacterium avium infection Non-Hodgkin's lymphoma Bronchial stenosis Mediastinal lymphadenopathy Homing
Received 平成21年9月15日
JJRS, 48(5): 397-403, 2010