PRESUMED NONTUBERCULOUS MYCOBACTERIAL LUN G INFECTION IN A GIRL WITH CHRONIC GRANULOMATOUS-DISEASE

A seven-year-old girl with chronic granulomatous disease developed a l ung infection in an area with bronchiectasis due to a fungal infection . Extensive microbiological studies including examination of a lung bi opsy specimen were negative. A nontuberculous mycobacterial (NTM) infe ction due to Mycobacterium avium-intracellulare was suspected on the b asis of presence in the lung biopsy specimen of necrotic tuberculoid g ranulomas, positive serological tests for mycobacteria, and the develo pment of larger wheals in response to skin tests with M. avium and M. intracellulare antigens as compared with tuberculin. The patient recov ered slowly under isoniazid, clofazimine, rifabutine, and clarithromyc in. There have been few reports of NTM infections of the lung in patie nts with chronic granulomatous disease. The diagnosis in this case is discussed. Factors that may promote NTM lung infections in patients wi th chronic granulomatous disease are reviewed. The antimicrobial treat ment of NTM infections is outlined.