Pseudotumour of the lung caused by Mycobacterium malmoense infection in an HIV positive patient.

A case of pulmonary Mycobacterium malmoense infection presenting as a pseudotumour of the lung in a severely immunosuppressed HIV infected patient is reported. (Thorax 1994;49: 179-180) Figure 1 Chest radiograph showing a confluent area of consolidation in the left upper zone. Department of Genitourinary Medicine K Yoganathan A L Pozniak Department of Thoracic Medicine M W Elliott J Moxham King's College Hospital, London SE5 9RS Public Health Laboratory, Dulwich Hospital, London SE22 8QF M Yates Reprint requests to: Dr K Yoganathan. Received 27 November 1992 Returned to authors 9 February 1993 Revised version received 12 March 1993 Accepted for publication 14 April 1993 In June 1985 a 27 year old homosexual man presented with generalised lymphadenopathy and was diagnosed HIV antibody positive. He remained well until May 1987 when he developed angular cheilitis, folliculitis, and oral hairy leucoplakia. In March 1988 he had been given zidovudine and co-trimoxazole in view of his persistently low CD4 count of less than 200 cells/Il. Anaemia and neutropenia developed which resolved after stopping these drugs. Nebulised pentamidine was substituted for co-trimoxazole. He was later rechallenged with low dose zidovudine but his anaemia recurred. His compliance with nebulised pentamidine was poor, and in October 1990 he had an episode of bronchoscopically confirmed Pneumocystis carinii pneumonia. He was treated with standard high dose co-trimoxazole and made a full recovery. In May 1991 he complained of left pleuritic chest pain, low grade fever, and weight loss. His chest radiograph showed a confluent area of consolidation in the left upper zone (fig 1), a lateral film indicating involvement of the apical segment of the left lower lobe. His CD4 lymphocyte count at this time was 25 cells/Id. No bacterial pathogens were found in the sputum which was also repeatedly negative for acid fast bacilli. Viral titres and an atypical pneumonia screen were negative. He was initially treated with erythromycin and amoxycillin but, because of persistent symptoms and worsening of his chest radiograph, his treatment was changed to ciprofloxacin 750 mg twice daily and he improved clinically. A month later he was readmitted with frank haemoptysis. His chest radiograph showed that there was now cavitation within the left Figure 2 Chest radiograph showing a large cavity in the left upper zone. upper zone shadowing (fig 2). Bronchoscopic examination showed a white necrotic tumourlike mass occluding the apical segment of the left lower lobe which looked like a carcinoma of the bronchus. Bronchial lavage contained no malignant cells or acid fast bacilli but a biopsy of the "tumour" showed numerous macrophages filled with acid fast bacilli. Mycobacterium malmoense was cultured from the biopsy 179 Thorax 1994;49:179-180 group.bmj.com on June 3, 2017 Published by http://thorax.bmj.com/ Downloaded from