Diagnostic pitfall: Mycobacterium avium complex pulmonary infection and positive ANCA

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• 作者：Shoaib Faruqi ; Jack A. Kastelik ; Damian V. McGivern
• 关键词：Non-tuberculous mycobacteriae ; Mycobacterium avium complex ; Vasculitis ; Anti-neutrophil cytoplasmic antibodies
• 刊名：European Journal of Internal Medicine
• 出版年：2008
• 出版时间：May 2008
• 年：2008
• 卷：19
• 期：3
• 页码：216-218
• 全文大小：165 K

文摘

We report the case of a 58-year-old female who presented with productive cough, weight loss, pulmonary nodular infiltrates and cavitations. She had a positive anti-neutrophil cytoplasmic antibodies (ANCA) test. A diagnosis of vasculitis was considered and a video-assisted thoracoscopic biopsy of the lung nodules was organised. However, prior to the biopsy, the sputum results revealed the presence of acid-fast bacilli, which were identified as Mycobacterium avium complex. A repeat ANCA assay was positive for atypical ANCA with negative proteinase-3 and myeloperoxidase titres. The patient was treated with rifampicin, ethambutol and clarithromycin with clinical and radiological improvement. The objective of this report is to highlight a rare association between positive ANCA titres and a non-tuberculous mycobacterial infection as a misdiagnosis and treatment of this patient with immunosuppressive therapy might have led to serious consequences.