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• W2049209848 abstract "To the Editor: We previously reported a case of endobronchial Mycobacterium avium-intracellulare infection (MAI) in a patient with AIDS whom we evaluated for massive hemoptysis.1Mehle ME Adamo JP Mehta AC Wiedemann HP Keys T Longworth DL Endobronchial Mycobacterium avium-intracellulare infection in a patient with AIDS.Chest. 1989; 96: 199-201Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Bronchoscopic examination initially disclosed no specific abnormality with the exception of a fresh clot in the posterior segment of the right upper lobe bronchus. A second bronchoscopy performed for evaluation of recurrent massive hemoptysis revealed a clot in the same location. Bronchial artery embolization of the corresponding vessels was therefore performed to control bleeding. One month later a third bronchoscopy performed as a follow-up evaluation disclosed multiple, partially obstructing, polypoid endobronchial lesions. Endobronchial biopsies were performed. Histologic examination revealed necrotizing and non-necrotizing granulomas, and the tissue cultures ultimately grew MAI. Five months later, recurrent hemoptysis, fever, and a chest radiograph typical of bronchiectasis necessitated endobronchial examination. Polypoid masses occluding multiple bronchial segments were partially removed using biopsy forceps, which allowed drainage of purulent material from the distal airways. During the next nine months, the patient's clinical course was dominated by recurrent maxillary sinusitis resistant to multiple courses of antibiotics (amoxicillin-clavulanate, ciprofloxacin); progressive bilateral, interstitial lower lobe infiltrates; and progressive CMV retinitis. Intravenous DHPG and prophylactic therapy with aerosolized pentamidine and oral zidovudine in addition to cyclic antibiotics (erythromycin, tetracycline, cefadroxil) and monthly gamma globulin injections for control of lower airway infection were utilized over this same period. Bronchoscopy performed for evaluation of the lower lobe interstitial infiltrates 14 months after the initial airway examination demonstrating endobronchial lesions revealed absence of polypoid airway masses (Fig 1). Transbronchial biopsies were unremarkable for infectious organisms or a specific pathologic abnormality. Cytomegalic virus was recovered from bronchoalveolar lavage fluid cultures, but cultures for MAI organisms were negative. The patient continued to experience frequent bouts of sinusitis and minor episodes of hemoptysis. During September, 1989 his sputum cultures again turned positive for MAI. However, bronchoscopy performed on October 10, 1989 revealed no bleeding source or evidence of recurrence of endobronchial MAI. To the best of our knowledge this is the first report in the English literature of spontaneous resolution of endobronchial MAI in a patient with AIDS. None of the medications the patient received during the time of evaluation for hemoptysis and parenchymal lung disease have demonstrated clinical bactericidal activity against MAI, although ciprofloxacin in combination with imipenem and amikacin has demonstrated in vitro activity against MAI.2Inderlied CB Kolonski PT Wu M Young LS Amikacin, ciprofloxacin, and imipenem treatment for disseminated Mycobacterium avium complex infection of beige mice.Antimicrob Agents Chemother. 1989; 33L: 176-180Crossref Scopus (37) Google Scholar We conclude that, similar to parenchymal MAI, endobronchial MAI may be self-limiting3Davidson PT The diagnosis and management of disease caused by M avium complex, M kansasii and other mycobacteria.Clin Chest Med. 1989; 10: 431-443PubMed Google Scholar and hypothesize that in this patient it may reflect immunologic reconstitution, perhaps facilitated by zidovudine and gamma globulin.4Fauci AS Lane HC Antiretroviral therapy and immunologic reconstitution in AIDS.Ann Instit Pasteur Immunol. 1987; 138: 261-268Crossref Scopus (3) Google Scholar, 5Yarchoan R Broder S Development of antiretroviral therapy for the acquired immunodeficiency syndrome and related disorders. A progress report.N Engl J Med. 1987; 316: 557-564Crossref PubMed Scopus (197) Google Scholar, 6Yap PL Williams PE Treatment of human immunodeficiency virus infected patients with intravenous immunoglobulin.J Hosp Infect. 1988; 12: 35-46Abstract Full Text PDF PubMed Scopus (4) Google Scholar The other medications played a minor role at best in the eradication of this infection." @default.
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• W2049209848 title "Spontaneous Resolution of Endobronchial Mycobacterium avium-intracellulare Infection in a Patient with AIDS" @default.
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• W2049209848 doi "https://doi.org/10.1378/chest.98.6.1540b" @default.
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