1887
Volume 2015, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Nontuberculous mycobacterial infection in an immunocompetent young patient complicated with empyema and pneumothorax is rarely reported. A 36-year-old man presented to the emergency department with a history of worsening dyspnea and pleuritic chest pain. The patient had unstable vital signs on presentation, and was referred to the resuscitation area on a monitored bed. The patient had a chest x-ray (CXR) performed on a prior occasion at a primary health clinic, revealing pneumothorax and some fluid at the left costophrenic angle. On arrival at the hospital, bedside ultrasound was performed which confirmed the diagnosis of pneumothorax. His vital signs were pulse 153, BP 88/62, RR 50 breaths per minute and his oxygen saturation on air was 92%. Tension pneumothorax was diagnosed based on clinical presentation and given vital signs. It was managed immediately with needle decompression followed by chest tube insertion. The patient improved dramatically after needle decompression with stabilization of vital signs. A CXR was repeated post-needle decompression which showed an incompletely resolved pneumothorax with an increase in the size of the effusion. Iatrogenic haemothorax was a possible explanation for this increase in effusion size. Chest tube was successfully inserted in the fourth intercostal space just anterior to the midaxillary line under full aseptic precautions. The chest tube drained 1.4 liters of blood, which on analysis showed a low pH and elevated adenosine deaminase level. Two out of three sputum samples sent from the medical ward were positive for mycobacteria other than tuberculosis as confirmed on culture. The patient's symptoms improved with percutaneous tube drainage of hemopneumothorax and antituberculous medications.

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2015-07-02
2019-10-17
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References

  1. [1]. Glassroth   J. . Pulmonary disease due to nontuberculous mycobacteria. . CHEST . 2008; ;133: 1 : 243– 251 .
    [Google Scholar]
  2. [2]. Lim   JG., , O   SW., , Lee   KD., , Suk   DK., , Jung   TY., , Shim   TS., , Chon   GR. . Mycobacterium intracellulare pleurisy identified on liquid cultures of the pleural fluid and pleural biopsy. . Tuberc Respir Dis . 2013; ;74: 3 : 124– 128 .
    [Google Scholar]
  3. [3]. Christensen   EE., , Dietz   G., , Ahn   C., , Chapman   JS., , Murry   RC., , Anderson   J., , Hurst   GA. . Initial roentgenographic manifestations of pulmonary Mycobacterium tuberculosis, M kansasii, and M intracellularis infections. . CHEST . 1981; ;80: 2 : 132– 136 .
    [Google Scholar]
  4. [4]. Kakugawa   T., , Mukae   H., , Kajiki   S., , Tanaka   A., , Yamayoshi   T., , Inoue   M., , Ohtani   H., , Sakamoto   N., , Izumikawa   K., , Tasaki   H., , Ooe   N., , Kohno   S. . Mycobacterium avium pleuritis in a non-immunocompromised patient. . Intern Med . 2008; ;47: 19 : 1727– 1731 .
    [Google Scholar]
  5. [5]. Hagiwara   E., , Komatsu   S., , Nishihira   R., , Shinohara   T., , Baba   T., , Ogura   T. . Clinical characteristics and prevalence of pneumothorax in patients with pulmonary Mycobacterium avium complex disease. . J Infect Chemother . 2013; ;19: 4 : 588– 592 .
    [Google Scholar]
  6. [6]. Kobashi   Y., , Mouri   K., , Obase   Y., , Kato   S., , Oka   M. . Clinical analysis of patients with pulmonary nontuberculous mycobacterial disease complicated by pneumothorax. . Intern Med . 2013; ;52: 22 : 2511– 2515 .
    [Google Scholar]
  7. [7]. Hagiwara   E., , Shiihara   J., , Enomoto   T., , Tsuchiya   N., , Baba   T., , Shinohara   T., , Nishihira   R., , Kato   T., , Ogura   T., , Takahashi   H. . [Clinical features of pneumothorax in patients with active nontuberculous mycobacterial lung disease]. . Nihon Kokyuki Gakkai Zasshi . 2010; ;48: 2 : 104– 107 .
    [Google Scholar]
  8. [8]. Martinez   S., , McAdams   HP., , Batchu   CS. . The many faces of pulmonary nontuberculous mycobacterial infection. . AJR Am J Roentgenol . 2007; ;189: 1 : 177– 186 .
    [Google Scholar]
  9. [9]. Kortbeek   JB., , AlTurki   SA., , Ali   J., , Antoine   JA., , Bouillon   B., , Brasel   K., , Brenneman   F., , Brink   PR., , Brohi   K., , Burris   D., , Burton   RA., , Chapleau   W., , Cioffi   W., , Collet e Silva Fde   S., , Cooper   A., , Cortes   JA., , Eskesen   V., , Fildes   J., , Gautam   S., , Gruen   RL., , Gross   R., , Hansen   KS., , Henny   W., , Hollands   MJ., , Hunt   RC., , Jover Navalon   JM., , Kaufmann   CR., , Knudson   P., , Koestner   A., , Kosir   R., , Larsen   CF., , Livaudais   W., , Luchette   F., , Mao   P., , McVicker   JH., , Meredith   JW., , Mock   C., , Mori   ND., , Morrow   C., , Parks   SN., , Pereira   PM., , Pogetti   RS., , Ravn   J., , Rhee   P., , Salomone   JP., , Schipper   IB., , Schoettker   P., , Schreiber   MA., , Smith   RS., , Svendsen   LB., , Taha   W., , van Wijngaarden-Stephens   M., , Varga   E., , Voiglio   EJ., , Williams   D., , Winchell   RJ., , Winter   R. . Advanced trauma life support, 8th edition, the evidence for change. . J Trauma . 2008; ;64: 6 : 1638– 1650 .
    [Google Scholar]
  10. [10]. Henry   M., , Arnold   T., , Harvey   J. . BTS guidelines for the management of spontaneous pneumothorax. . Thorax . 2003; ;58: suppl 2 : ii39– ii52 .
    [Google Scholar]
  11. [11]. Rawlins   R., , Brown   K., , Carr   C., , Cameron   C. . Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax. . Emerg Med J . 2003; ;20: 4 : 383– 384 .
    [Google Scholar]
  12. [12]. Seneff   M., , Corwin   RW., , Gold   LH., , Irwin   RS. . Complications associated with thoracocentesis. . CHEST . 1986; ;90: 1 : 97– 100 .
    [Google Scholar]
  13. [13]. Ali   J., , Howard   M., , Williams   J. . Is attrition of advanced trauma life support acquired skills affected by trauma patient volume?.   Am J Surg . 2002; ;183: 2 : 142– 145 .
    [Google Scholar]
  14. [14]. Ferrie   E., , Collum   N., , McGovern   S. . The right place in the right space? Awareness of site for needle thoracocentesis. . Emerg Med J . 2005; ;22: 11 : 788– 789 .
    [Google Scholar]
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