PMC4821332_01
Serial computed tomography (CT) findings in the husband. (a), (b); CT scan at first admission in October 2013 shows bilateral ground glass opacities and nodular shadows in both lung fields. (c); CT scan 3 weeks after the first admission shows remarkable improvement in the ground glass opacities. (d); CT scan at the second admission in June 2014 once again shows bilateral ground glass opacities. The bilateral nodular shadows have increased in comparison to the first admission and bronchiectasis has appeared in the left lingual lobe. (e); CT scan from August 2015 shows minimal persistence of the bilateral ground glass opacities. Diffuse bilateral nodular shadows persist.
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Bilateral ground glass opacities were observed on chest radiography and computed tomography in both patients (husband, Fig. 1a and b; wife, Fig. 2a and b). In addition, nodular shadows were present in both lung fields in the husband (Fig. 1a and b), and in right upper lung lobe (right S2) in the wife (Fig. 2a and b). Chest computed tomography findings at three weeks after admission showed improvement of the bilateral ground glass opacities in both patients (husband, Fig. 1c; wife, Fig. 2c). Bilateral ground glass opacities were observed once again on chest radiography and computed tomography in both patients (husband, Fig. 1d; wife, Fig. 2d). The appearance of bilateral ground glass opacities on computed tomography was minimal in both patients (husband, Fig. 1e; wife, Fig. 2e).
Changes in serum Krebs Von Den Lungen-6 (KL-6) levels. In both the husband and wife, serum KL-6 levels declined from winter to spring and were elevated from summer to autumn.
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The serum Krebs Von Den Lungen-6 (KL-6) levels were elevated at 839 U/mL and 721 U/mL in the husband and wife, respectively (normal range, <500 U/mL) (Fig. 3). During the winter and spring, they had no respiratory symptoms, such as dyspnoea on effort or cough, and serum KL-6 levels declined (Fig. 3). The highest serum KL-6 level was 1710 U/mL in the husband and 1360 U/mL in the wife, and these levels declined gradually (Fig. 3).
Mouldy rotten wood from under the sink in the patients' house. A mouldy rotten wood sample obtained from under the sink tested positive for M. intracellulare on polymerase chain reaction.
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August 2014. A mouldy rotten wood sample obtained from under the sink tested positive for M. intracellulare on polymerase chain reaction, and M. avium was cultured from a sludge sample from the bath overflow (Fig. 4).