ABSTRACT
Pulmonary artery pseudoaneurysm (PAP) is a very rare vascular abnormality and is often caused at least in part by infection. While Mycobacterium tuberculosis is a relatively common cause of PAP, it can also result from a lung abscess. Aneurysm rupture resulting in massive hemoptysis is potentially fatal, with death caused by aspiration of blood and consequent asphyxiation. We admitted a 55-year-old man with massive hemoptysis. He had been treated with intravenous antibiotics for three weeks after diagnosing a lung abscess. Contrast-enhanced chest computed tomography revealed a pseudoaneurysm inside the abscess. Diagnostic catheter pulmonary angiography confirmed the diagnosis of pseudoaneurysm of the pulmonary artery. Embolization successfully controlled the airway bleeding. However, the patient died of acute respiratory failure on the seventh hospital day. When hemoptysis is due to sustained inflammation, such as a lung abscess, bleeding from the pulmonary artery should be considered.
Subject(s)
Humans , Middle Aged , Abscess , Aneurysm , Aneurysm, False , Angiography , Anti-Bacterial Agents , Catheters , Diagnosis , Hemoptysis , Hemorrhage , Inflammation , Lung Abscess , Lung , Mycobacterium tuberculosis , Pulmonary Artery , Respiratory Insufficiency , Rupture , ThoraxABSTRACT
Tumor necrosis factor-alpha (TNF-alpha) is a key component of the host defense against mycobacterial infection. Mycobacterium gordonae (M. gordonae) is one of the least virulent mycobacteria, and is generally considered non-pathogenic if detected from a clinical specimen. Here, we report a rare case of pulmonary M. gordonae infection in a patient with ulcerative colitis who had been treated with infliximab, a TNF-alpha antagonist. M. gordonae infection was treated successfully with clarithromycin, rifampin, and ethambutol. We believe this to be the first report of M. gordonae pulmonary disease associated with TNF-alpha antagonist treatment.
Subject(s)
Humans , Clarithromycin , Colitis, Ulcerative , Ethambutol , Gordonia Bacterium , Lung Diseases , Mycobacterium , Nontuberculous Mycobacteria , Rifampin , Tumor Necrosis Factor-alpha , Ulcer , InfliximabABSTRACT
Pulmonary pneumatoceles are air-filled thin-walled spaces within the lung and are rare in adult cases of pneumonia. We report the case of a 74-year-old male who was admitted with a cough and sputum production. He had been treated with oral dexamethasone since a brain tumorectomy 6 months prior. Contrast-enhanced computed tomography (CT) of the chest revealed a large pneumatocele in the right middle lobe and peripheral pneumonic consolidation. Bronchoalveolar lavage was performed; cultures identified extended-spectrum beta-lactamase (ESBL) producing Proteus mirabilis. A 4-week course of intravenous ertapenem was administered, and the pneumatocele with pneumonia resolved on follow-up chest CT. To the best of our knowledge, this is the first reported case of pulmonary pneumatocele caused by ESBL-producing P. mirabilis associated with pneumonia.