We report a case of extensive mediastinal lymphadenopathy in a 29-year-old immunocompetent woman, which was thought to be caused by Mycobacterium tuberculosis (MTB). Chest radiographs showed deterioration while the patient was receiving antituberculous medication for 8 months. After isolation of Mycobacterium avium complex (MAC) from a lymph node aspiration biopsy and switch to a MAC-specific therapeutic regimen, the lesion almost completely disappeared within 1 year. To our knowledge, this is the first report of an extensive mediastinal lymphadenopathy caused by MAC in an immunocompetent adult.
BackgroundDisseminated mycobacterium avium complex (MAC) occurs mainly in immunocompromised hosts, which is associated with abnormal cellular immunity.Case presentationA 26-year-old pregnant woman presented with fever and general weakness. Miliary lung nodules were noted on chest X-ray. Under the impression of miliary tuberculosis, anti-tuberculosis medication was administered. However, the patient was not improved. Further work-up demonstrated MAC in the sputum and placenta. The patient was treated successfully with clarithromycin-based combination regimen.ConclusionThis appears to be the first case of disseminated MAC in an otherwise healthy pregnant woman. Clinicians should be alert for the diagnosis of MAC infection in diverse clinical conditions.
A male infant aged 3 months and 1 week had persistently high fever with parotitis that was unresponsive to antibiotics. Mumps was identified by serologic study, but he was finally diagnosed by clinical features as having Kawasaki disease and echocardiographic findings on the 9th day of fever. Parotitis, which is unresponsive to antibiotics, should be considered Kawasaki disease even though typical symptoms are not present. (Korean Circ J 2009; 39:502-504)