PMC5109579_01
The patient's dermal manifestations. a: The anterior chest nodule (5 cm in diameter). A soft, painless lesion was attached to the patient's sternum. b: Small, red papules with clear margins were present on the patient's back.
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A solitary red nodule (5 cm in diameter) was present on his anterior chest (Fig. 1a). Multiple small, red papules (maximum size: 2 mm) were present on his trunk (Fig. 1b). AFB was also detected in the eye discharge (1+), purulent discharge from the right cheek (2+), and a biopsy specimen from a mass-like lesion of the right lower bronchus and the chest nodule (3+) by Ziehl-Neelsen staining (Fig. 1b). All of these AFB were confirmed to be M. avium by PCR.
A chest computed tomography scan and bronchoscopic findings. a: Atelectasis of the right lower lobe. b: A tumor-like legion occluded the right lower bronchus.
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On chest computed tomography, the right inferior lobar bronchus was completely occluded by a tumor-like lesion (1 cmx1 cm in size), resulting in complete atelectasis of his right lower lung (Fig. 2a). Bronchoscopy showed that the tumor-like lesion completely occluded the right lower bronchus (Fig. 2b).
Pathological findings. a: Ziehl-Neelsen staining of the tumor-like legion that occluded the right lower bronchus (400x). The black arrowhead shows numerous acid-fast bacilli. b: Ziehl-Neelsen staining of the anterior chest nodule (400x). Numerous acid-fast bacilli were also detected (black arrowhead). c: Immunostaining of the anterior chest nodule (400x). The nodule was infiltrated by CD68-positive macrophages (black arrowhead).
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AFB (Fig. 3a). Additionally, numerous AFB (Fig. 3b) and a xanthogranuloma with histiocytic infiltration positively stained with CD68 (Fig. 3c) were detected in the chest nodule.
Change in Mycobacterium avium-infected lesions before and after the patient underwent anti-mycobacterial chemotherapies. The right facial purulent lesions before treatment (a: black arrowhead) were improved after 4 months of undergoing the chemotherapies (b: white arrowhead). Swelling in the retrobulbar part of both optic nerves (c: inside of the black rectangles) disappeared after 2 months of undergoing the chemotherapies (d: inside of the white rectangles).
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Brain magnetic resonance imaging (MRI) showed swelling in the retrobulbar part of both optic nerves (Fig. 4c). After 4 months of chemotherapy, the patient's general condition and the appearance of his skin lesions markedly improved (Fig. 4a and b). Follow-up orbital MRI showed obvious improvement in swelling of both optic nerves (Fig. 4c and d).