SHM Converge Scientific Abstract ePoster Gallery-Pleural Mycobacterium Avium Complex Infection: A Rare Cause of Refractory Bronchopleural Fistula

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A 74-year-old woman with MPO-ANCA interstitial lung disease, on immunosuppression (rituximab and hydroxychloroquine), and heart failure developed sudden chest pain and shortness of breath while straining during a bowel movement. She was found to have a left pneumothorax with early tension physiology, requiring emergent chest tube placement. Her course was complicated by a persistent air leak and refractory bronchopleural fistula.<br /><br />Despite prolonged management, including surgical exploration and later bronchoscopic placement of seven endobronchial valves to occlude the left upper lobe and lingula, the air leak and pneumothorax recurred. Operative findings included an 8-mm lung defect and yellow exudative material coating the parietal pleura. Pathology showed necrotizing granulomatous inflammation with rare acid-fast bacilli, and pleural cultures grew Mycobacterium avium complex (MAC). She was treated with azithromycin, ethambutol, and rifabutin.<br /><br />MAC pleural infection is rare and usually occurs with disseminated disease or direct extension from pulmonary infection. In this case, pleural MAC infection likely contributed to the refractory bronchopleural fistula and poor response to surgical and bronchoscopic interventions. Because of limited respiratory reserve from advanced interstitial lung disease, further interventions such as complete left lung occlusion with endobronchial valves were not pursued. After goals-of-care discussions, she chose comfort-focused care and died shortly thereafter.<br /><br />This case highlights that persistent air leak in hospitalized patients, especially those with structural lung disease or immunosuppression, should prompt consideration of nontuberculous mycobacterial pleuritis. Early multidisciplinary evaluation is crucial in managing these complex cases.

Asset Subtitle

Allison A. Reinhardt

Meta Tag

Author List Allison A. Reinhardt

Category Clinical Vignettes

Concept Pleural Mycobacterium avium complex infection

Concept Refractory bronchopleural fistula

Concept Persistent air leak

Concept Structural Lung Disease

Concept Immunosuppression

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Allison A. Reinhardt

Track Adult

Keywords

MPO-ANCA interstitial lung disease

immunosuppression

pneumothorax

tension physiology

persistent air leak

bronchopleural fistula

endobronchial valves

Mycobacterium avium complex

pleural infection

necrotizing granulomatous inflammation

Pleural Mycobacterium avium complex infection

Refractory bronchopleural fistula

Persistent air leak

Structural Lung Disease

Immunosuppression