Objective To study the
diagnosis and
treatment of
Mycobacterium avium complex lung disease with severe
renal insufficiency ,and to provide a basis for improving the
clinical diagnosis and
treatment of MAC
lung disease with severe
renal insufficiency .
Methods Clinical data of an
elderly patient with MAC
lung disease confirmed by
induced sputum culture and complicated with
chronic kidney disease (CKD 4) was reported.The related
literatures at home and abroad were reviewed.Results A
male patient aged 80 years with poor
nutrition was suffering from progressive
weight loss ,exhaustion and night
sweats .His weight was only 43-44 Kg.
Chest CT showed that multiple small nodules,small spot pieces of shadow and ground
glass shadows in bilateral
lung tissues .
PET /CT indicated that spot pieces and nodules with metabolic activity in high performance.
Bronchoalveolar lavage fluid (BALF) inspection was negative.MAC was identified by
induced sputum culture through high
permeability brine
induced sputum .It was difficult to choose
drugs for the
treatment of MAC
lung disease due to his poor
kidney function [GFR of left
kidney 9.0 ml /min,GFR of right
kidney 18.8 ml/min].Conventional anti-
mycobacterium drugs showed a low to high resistance to MAC.
Moxifloxacin was discontinued for
renal insufficiency .His condition was stable after choosing trimodality
therapy including
azithromycin 0.25 g/d tiw,rifapentine 0.3 g/d biw,
ethambutol 0.375 g /d tiw and the joining
immunotherapy .Conclusions
PET / CT is not useful in identifying
tuberculosis and MAC
lung disease .The
treatment of MAC
lung disease is difficult in
elderly patients with severe
renal insufficiency and low weight.Individual
therapy combined with
immunotherapy and improving the
nutrition state is a good choice for the
treatment of MAC
lung disease in
elderly patients with severe
renal insufficiency .The anti-MAC
drugs should be carefully selected and the adverse reactions should be closely observed in order to obtain the satisfactory clinical results.