RELAPSE OF PULMONARY MYCOBACTERIUM-KANSASII DISEASE-ASSOCIATED WITH LARGE-CELL CANCER OF THE LUNG - A CASE-REPORT

A 43-year-old Caucasian male diabetic presented with purulent cough an d a history of weight-loss, elevated temperature, night-sweat and dysp nea. Four years previously, the patient had undergone a 12-month antim ycobacterial regimen because of pulmonary mycobacterium kansasii (MK) disease of the left upper lobe (LUL). Treatment had led to complete re covery with the exception of minor fibrous residuals in the involved p ulmonary segments. Chest radiograph and computed tomography (CT), perf ormed on recent admission, revealed a dense infiltration of these resi dual-containing segments. Microbiological evaluation of bronchial brus hings, aspirates and histology of the transbronchial biopsies indicate d a relapse of pulmonary MK disease. Although antimycobacterial treatm ent was started immediately, therapeutic effects were only minimal and remained to be limited to the initial phase of the treatment. After f our weeks of treatment, the patient's general condition worsened again . Follow-up CT of the lung showed a marked increase of the infiltratio n in the left apicoposterior lobe and re-bronchoscopy showed a tumorou s protrusion of the bronchial wall involving the apicoposterior segmen t ostium, a finding which was not seen in the previous bronchoscopy. H istology of the transbronchial biopsies revealed a carcinoma mainly fr om large-cell type.