Cases reported "Bronchial Diseases"

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1/6. mycobacterium avium complex causing endobronchial disease in AIDS patients after partial immune restoration.

    OBJECTIVE: To report the development of an unusual manifestation of pulmonary mycobacterium avium complex (MAC) infection in two patients with the acquired immune-deficiency syndrome (AIDS) after the commencement of combination antiretroviral chemotherapy. patients: Two Caucasian males with human immunodeficiency virus (hiv) infection and CD4 lymphocyte counts <0.05 x 10x9/1 and with plasma hiv polymerase chain reaction (PCR) >100,000 copies/ml who were commenced on combination antiretroviral chemotherapy including a protease inhibitor. RESULTS: Both patients developed endobronchial polypoid tumours within two months of commencing antiretroviral chemotherapy. histology demonstrated granuloma formation and acid-fast bacilli. Tissue from both patients grew M. avium. Both patients achieved significant suppression of viral replication and had significantly improved CD4 lymphocyte counts. Both required antimycobacterial therapy. CONCLUSIONS: Endobronchial polypoid tumours due to MAC infection have only been described in hiv-infected patients receiving antiretroviral chemotherapy. A degree of restored immunity is implicated in the pathogenesis of this unusual disease.
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2/6. Endobronchial lesions involved in Mycobacterium avium infection.

    Mycobacterium avium (M. avium) has been described traditionally as an opportunistic organism that causes disseminated disease in the human immunodeficiency virus (hiv)-positive population and that acts as a pulmonary pathogen in patients with underlying lung disease such as chronic obstructive pulmonary disease (COPD) or previously diagnosed tuberculosis. Pulmonary involvement of M. avium may range from asymptomatic colonization of the airway to invasive parenchymal or cavitary disease. However, endobronchial lesions involved in M. avium infection are rare in either immunocompetent or immunosuppressed hosts. We report here endobronchial mycobacterial infection in a hiv-negative patient.
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3/6. Tracheobronchial obstruction due to silicosis.

    Broncholithiasis can result in airway obstruction through the erosion of calcified lymph nodes into the bronchial lumen or by extrinsic compression of the tracheobronchial tree. We report an unusual case of broncholithiasis in a patient with silicosis who developed airway obstruction from endobronchial polypoid masses of granulation tissue adjacent to calcified mediastinal lymph nodes. The production of granulation tissue may have been the result of broncholiths in the early stages of erosion into the tracheobronchial tree. Efforts to ablate the endobronchial polyps using YAG laser phototherapy were only temporarily successful and surgical removal of the calcified mediastinal lymph nodes was required to halt further polyp growth. Surgical specimens grew Mycobacterium avium-intracellulare (MAI), a common pathogen in patients with silicosis. MAI may have contributed to the local inflammatory milieu provoking the exuberant tissue response.
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keywords = avium
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4/6. Endobronchial mycobacterium avium-intracellulare infection in a patient with AIDS.

    The pulmonary manifestations of AIDS are well described in the medical literature; however, MAI infection presenting as an endobronchial lesion has not, to our knowledge, been reported in a patient with AIDS. We report a unique case of an AIDS patient who developed endobronchial polypoid lesions secondary to MAI infection. Complications resulting from these lesions included hemoptysis and later bronchiectasis.
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5/6. mycobacterium avium complex infection presenting as endobronchial lesions in immunosuppressed patients.

    Infections caused by Mycobacterium avium in relatively immunocompetent hosts usually occur with isolated pulmonary involvement. patients with the acquired immunodeficiency syndrome (AIDS) more commonly have disseminated disease. Endobronchial masses, however, have not been described with M. avium complex infections in normal or compromised hosts. We describe the cases of two patients with AIDS, both receiving zidovudine therapy, who presented with endobronchial obstruction and hilar adenopathy. Results of radiographic and endobronchial examination of these lesions suggested malignancy. Histologic and microbiologic tests, however, showed M. avium, and the lesions responded remarkably to mechanical debridement and antimycobacterial therapy.
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keywords = avium
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6/6. Endobronchial lesions in a non-AIDS patient with disseminated mycobacterium avium-intracellulare infection.

    A 34 year old female developed mycobacterium avium-intracellulare infection with generalized lymphadenopathy, hepatosplenomegaly, pulmonary infiltration, pleural effusion and endobronchial polypoid lesions. M. avium-intracellulare was identified by means of sputum cultures, pleural effusion culture and lymph node culture. The anti-human immunodeficiency virus (hiv) antibody was negative. The CD4 cell count was normal. Bronchoscopic examination revealed multiple polypoid lesions, which had nearly occluded the right main bronchus, right middle lobe and left lower lobe bronchi. neodymium yttrium aluminium garnet (Nd-YAG) laser and antimycobacterial therapy were used effectively to relieve the airway obstruction. The clinical symptoms and signs responded favourably to antimycobacterial therapy.
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