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A Case of Mycobacterium avium Pulmonary Disease with Massive Pleural Effusion in an HIV-negative, Nonimmunosuppressed Patient: Using PCR-Restriction Fragment Length Polymorphism Assay
Sang Soo Kim, M.D.1, Eun Jae Rhie, M.D.1, Geun Jun Ko, M.D.1, Hyung Seob Choi, M.D.1, Hwa Eun Oh, M.D.2, June Myung Kim, M.D.3 and Kkot Sil Lee, M.D.1
Department of Internal1 and Pathologic Medicine2, College of Medicine, Kwandong University, Koyang Department of Internal Medicine, Yonsei University College of Medicine3, Seoul, Korea
Vol.36 Num.6 (p381~385)
The Mycobacterium avium complex (MAC) comprises slow-growing mycobacteria that is ubiquitous in the environment and capable of infecting diverse species with consequences ranging from asymptomatic infection to clinically significant and even fatal disease. Especially, basal pleural disease is infrequently found in immunocompetent person. We report a very rare case of M. avium pleuritis with massive pleural effusion without any predisposing conditions. A previously healthy 36-year-old man was admitted to our hospital because of generalized malaise, low-grade fever, and right pleuritic chest pain of 5 days' duration. Chest X-ray showed mottled infiltration in the right upper lung zone with minimal right pleural effusion which was exudate with lymphocyte-dominance. The pleural effusion progressively increased without responding to anti-tuberculosis treatment. Afterwards M. avium was identified from the pleural effusion using PCR-Restriction Fragment Length Polymorphism Assay(PCR-RFLP). The treatment regimen was changed to rifampine, ethambutol, clarithromycin and streptomycin afterwhich the patient recovered.
Keywords : Mycobacterium-avium complex, Pleural effusion, Restriction Fragment Length Polymorphism Assay