Open AccessCoexistence of nontuberculous mycobacterium and IgG4-related disease in a solitary pulmonary nodule
Author(s) -
Kyungsoo Bae,
Hyo Jung An,
Kyung Nyeo Jeon,
Dae Hyun Song,
Sung Hwan Kim,
Ho Cheol Kim
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000018179
Subject(s) - medicine , nodule (geology) , pneumonia , solitary pulmonary nodule , igg4 related disease , thoracoscopy , sputum , lung abscess , lung , lung cancer , extracorporeal membrane oxygenation , tuberculosis , radiology , pathology , disease , paleontology , biology
Rationale: Immunoglobulin G4-related disease (IgG4-RD) is regarded as an immune-mediated systemic fibroinflammatory disease. Several studies have linked IgG4-RD to infections such as tuberculosis and actinomycosis. However, the coexistence of IgG4-RD and non-tuberculous mycobacterium (NTM) in a single pulmonary nodule has not been reported yet. Patient concerns: A 76-year-old male patient presented with cough and sputum. A solitary pulmonary nodule suspicious of lung cancer was found on chest CT. Diagnosis: Through video-assisted thoracoscopic biopsy, a diagnosis of co-existing NTM and IgG4-RD in a single nodule was made. Interventions: Antibiotic treatment was applied for pneumonia developed after surgery. The patient was also supported by extracorporeal membrane oxygenation and mechanical ventilation since his pneumonia was refractory to medical treatment. Outcomes: The patient expired on the 60th postoperative day due to multiple organ failure. Lessons: IgG4-RD can occur singularly or accompanied by other diseases. We report a solitary pulmonary nodule caused by NTM and concurrent IgG4-RD, suggesting a possible association between these 2 entities. Immunologic relations between IgG4-RD and accompanying infection should be further investigated.