A Case of Nontuberculous Mycobacterial Pulmonary Disease in a Patient with Previous Pulmonary Tuberculosis

Abstract

A young woman with previously treated pulmonary tuberculosis two years ago presented with dry cough, low-grade fever and weakness for last one year. She had a history of massive haemoptysis and had previously undergone right upper lobe apical segment resection for a suspected aspergilloma inside a post TB cavity. On examination, she was malnourished and had pallor and chest crepitations. Chest radiography showed bilateral infiltrates with fibrosis and bronchiectasis, while high-resolution computed tomography demonstrated nodules, patchy consolidation and fibrotic changes. Sputum examination for acid-fast bacilli was negative. However, bronchoalveolar lavage fluid grew nontuberculous mycobacteria on BACTEC culture after four weeks. Nontuberculous mycobacterial pulmonary disease was diagnosed and treatment with rifampicin, ethambutol and azithromycin was initiated. The case highlights the importance of considering nontuberculous mycobacterial disease in patients with structural lung disease and previous tuberculosis.