Mycobacterium Avium Complex Presenting as a Lung Mass, Broncho-pleural Fistula and Empyema in an Immunocompetent Patient-A Case Report and Review of Literature

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Suganya Chandramohan
Shirisha Pasula
Suganthini Krishnan Natesan


Mycobacterium avium complex (MAC) is a non-tuberculous mycobacteria (NTM) that causes subacute or chronic nodular bronchiectasis, cavitary or fibro-cavitary pneumonia in patients with chronic structural lung pathology including emphysema, chronic bronchitis, and bronchiectasis. It is also known to cause pulmonary and extrapulmonary infections in patients with impaired cell mediated immunity such as transplant recipients, (Acquired Immune Deficiency Syndrome) AIDS where it can cause disseminated infections. Empyema from MAC has been reported in immunocompromised patients and is a rare phenomenon. Here we report a patient who presented with chronic left pleural effusion and a left lower lobe lung mass that went undiagnosed for 2 years, despite extensive work-up. Later in his course, he presented with a large effusion complicated by a bronchopleural fistula and was diagnosed as MAC empyema. To our knowledge, this is the first case of MAC empyema, that presented as a chronic lung mass, complicated by a bronchopleural fistula. In this article, we present the clinical, laboratory, and radiological features, with emphasis on a combined medical and surgical approach in the management of MAC empyema. We also provide a brief overview of cases of MAC associated pleurisy and empyema that have been reported in literature.

Chronic pleural effusion, empyema, lung mass, Chronic Obstructive Pulmonary Disease (COPD), Mycobacterium Avium Complex (MAC), broncho-pleural fistula.

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Chandramohan, S., Pasula, S., & Natesan, S. K. (2020). Mycobacterium Avium Complex Presenting as a Lung Mass, Broncho-pleural Fistula and Empyema in an Immunocompetent Patient-A Case Report and Review of Literature. International Journal of Medical and Pharmaceutical Case Reports, 13(2), 18-25.
Case Study


Marras TK, Mendelson D, Marchand-Austin A, May K, Jamieson FB. Pulmonary nontuberculous mycobacterial disease, Ontario, Canada, 1998–2010. Emerg Infect Dis. 2013;19:1889–91.

Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in US Medicare beneficiaries. Am J Respir Crit Care Med. 2012;185: 881–6.

Prevots DR, Marras TK. Epidemiology of human pulmonary infection with nontuberculous mycobacteria: A review. Clin Chest Med. 2015;36:13-34.

Henkle E, Hedberg K, Schafer S, Novosad S, Winthrop KL. Population-based incidence of pulmonary nontuberculous mycobacterial disease in Oregon 2007 to 2012. Ann Am Thorac Soc. 2015;12:642–7.

Simons S, van Ingen J, Hsueh PR, Van Hung N, Dekhuijzen PN, Boeree MJ, van Soolingen D: Nontuberculous mycobacteria in respiratory tract infections, eastern Asia. Emerg Infect Dis. 2011;17: 343–349.

Namkoong H, Kurashima A, Morimoto K, Hoshino Y, Hasegawa N, Ato M, Mitarai S: Epidemiology of pulmonary nontuberculous mycobacterial disease, Japan. Emerg Infect Dis. 2016;22:1116–1117.

Cassidy PM, Hedberg K, Saulson A, McNelly E, Winthrop KL: Nontuberculous mycobacterial disease prevalence and risk factors: A changing epidemiology. Clin Infect Dis. 2009;49:124–129.

Van Ingen J, Turenne CY, Tortoli E, Wallace RJ Jr, Brown-Elliott BA. A definition of the Mycobacterium avium complex for taxonomical and clinical purposes, a review. Int J Syst Evol Microbiol. 2018;68:3666–77.

Jo KW, Kim JW, Hong Y, Shim TS: A case of empyema necessitans caused by Mycobacterium abscessus. Respir Med Case Rep. 2012;6:1–4.

Matsumoto T, Otsuka K, Tomii K: Mycobacterium fortuitum thoracic empyema: a case report and review of the literature. J Infect Chemother. 2015;21: 747–750.

Inzirillo, Francesco, Giorgetta Casimiro, Ravalli Eugenio, Tiberi Simon, Robustellini Mario, Della Pona, Claudio. Bronchopleural fistula, tuberculous empyema and bilateral lung destruction treated in various stages by medical and surgical intervention. Indian Journal of Thoracic and Cardiovascular Surgery. 2014;30:241-243.

DOI: 10.1007/s12055-014-0298-5

Ando T, Kawashima M, Matsui H, Takeda K, Sato R, Ohshima N, Nagai H, Kitani M, Hebisawa A, Ohta K: Clinical features and prognosis of nontuberculous mycobacterial pleuritis. Respiration. 2018; 96:507-513.

Asai K, Urabe N. Acute empyema with intractable pneumothorax associated with ruptured lung abscess caused by Mycobacterium avium. Gen Thorac Cardiovasc Surg. 2011;59(6):443-6.

Ikeda M, Takahashi K, Komatsu T, Tanaka T, Kato T, Fujinaga T: The frequency and treatment of pneumothorax associated with pulmonary nontuberculous mycobacterial infection. Gen Thorac Cardiovasc Surg. 2017;65:117–121.

Haider A, Schliep T, Zeana C. Nontuberculous mycobacterium disease with pleural empyema in a patient with advanced AIDS. Am J Med Sci. 2009; 338(5):418-20.

DeLeon TT, Chung HH, Opal SM, Dworkin JD. Mycobacterium avium complex empyema in a patient with interferon gamma autoantibodies. Hawaii J Med Public Health. 2014;73(9 Suppl 1):15-7.

Shu CC, Lee LN, Wang JT, Chien YJ, Wang JY, Yu CJ. Non-tuberculous mycobacterial pleurisy: An 8-year single-centre experience in Taiwan. Int J Tuberc Lung Dis. 2010;14:635–641.

Charles L. Daley, Jonathan M. Iaccarino, Christoph Lange, Emmanuelle Cambau, Richard J, Wallace, Jr. Treatment of nontuberculous mycobacterial pulmonary disease: An official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline Clinical Infectious Diseases®. 2020;71(4):1–36.

Aznar ML, Zubrinic M, Siemienowicz M, Hashimoto K, Brode SK, Mehrabi M, Patsios D, Keshavjee S, Marras TK. Adjuvant lung resection in the management of nontuberculous mycobacterial lung infection: A retrospective matched cohort study. Respir Med. 2018;142:1-6.

Kotani K, Hirose Y, Endo S, Yamamoto H, Makihara S. Surgical treatment of atypical Mycobacterium intracellulare infection with chronic empyema: a case report. J Thorac Cardiovasc Surg. 2005; 130(3):907-8.