Endobronchial Lesions Caused by Nontuberculous Mycobacteria in Apparently Healthy Pediatric Patients

Abstract

Pulmonary disease caused by nontuberculous mycobacteria in healthy children is rare, and its pathogenesis is unknown in most cases and standardized treatment is lacking. Here, we report various endobronchial manifestations in 5 patients including hitherto undescribed diffuse tracheobronchial granulomas in 2 patients. Bronchoscopic debulking was performed in all patients and tuberculostatic treatment in 4. All patients including 1 without tuberculostatic treatment showed remission.

PulmonaryMycobacterium Avium-IntracellulareComplex Infection in an Infant: A Silent and Coincidental Finding

“… 1 , 2 Favorable results with surgical treatment have been reported in immunocompetent children with intrathoracic MAC. 7 However, as presented in our patient and others, combination antimycobacterial therapy seems to be prudent and effective. 4 …”

“… 3 The majority of reported cases presented with cough and wheezing and half of the patients had associated fever. 3 , 7 Asymptomatic presentations of intrathoracic MAC in pediatric patients, however, are uncommon. Our case is remarkable for the silent clinical picture despite extensive lung disease and significant obstruction of a main bronchus by a large intrabronchial mass.…”

Unusual cause of refractory wheeze in a young child

“…Thoracic MAC infection is generally opportunistic and seen in heavily immunosuppressed patients or in those with structural lung abnormalities such as bronchiectasis 2 . However, endobronchial and mediastinal MAC has been previously reported in children considered immunocompetent, with both surgical and medical management approaches used 3–5 . In recent years, genetic syndromes of disseminated NTM infection have been associated with specific mutations in interferon‐gamma and interleukin‐12 synthesis and response pathways which can now be tested for.…”

“…2 However, endobronchial and mediastinal MAC has been previously reported in children considered immunocompetent, with both surgical and medical management approaches used. [3][4][5] In recent years, genetic syndromes of disseminated NTM infection have been associated with specific mutations in interferon-gamma and interleukin-12 synthesis and response pathways which can now be tested for. These have been grouped together and labelled MSMD.…”

Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology

“…Contraindications for transbronchial biopsy include relevant pulmonary hypertension and relevant coagulation disorders. However, the biopsy of bronchial structures or pathologies is almost always possible and may be helpful or irreplaceable in diagnosis confirmation (tumors [92], atypical mycobacteriosis [93], sarcoidosis [94,95], granulomatosis with polyangiitis [96]).…”