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We present a rare case of <span class="elsevierStyleItalic">Mycobacterium branderi</span> diagnosed by cryoEBUS&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 57-year-old male ex-smoker&#44; with human immunodeficiency virus &#40;HIV&#41; infection without active treatment by their own decision presented to a hospital because of weakness and weight loss&#46; Blood culture and virus test were negatives and chest X-ray showed no apparent lesions&#46; A cranial CT and lumbar puncture ruled out infection&#46; A positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; showed a hypermetabolic pulmonary nodule &#40;14<span class="elsevierStyleHsp" style=""></span>mm&#44; SUVmax 6&#46;76&#41; in left lower low &#40;LLL&#41; and enlarged mediastinal lymphadenopathies &#40;subcarinal 25<span class="elsevierStyleHsp" style=""></span>mm&#44; SUVmax 19&#46;03&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; EBUS-TBNA &#40;EB-1970UK&#44; Linear-Array&#59; Pentax Medical Company&#41; was performed under general anaesthesia by an anaesthesiologist using intravenous midazolam&#44; propofol and fentanyl&#46; With a 22-gauge needle &#40;ECHO-HD-22-EBUS-O&#44; Cook Medical Company&#41;&#44; we performed two punctures and obtained cytological samples and cell blocks&#44; evaluated by rapid on-site evaluation &#40;ROSE&#41;&#46; Then procedure with 22-gauge histological needle &#40;ECHO-HD-22-EBUS-O-C&#41;&#44; and after two punctures&#44; a cryoEBUS was performed in subcarinal region&#44; introducing a 1&#46;1<span class="elsevierStyleHsp" style=""></span>mm cryo-probe &#40;Erbecryo 20402-401&#44; Tubingen&#44; Germany&#41;&#44; obtaining three cryobiopsies &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The procedure was well tolerated and no complications were observed&#44; nor 72<span class="elsevierStyleHsp" style=""></span>h later&#46; Cytological studies showed lymphocytes without malignant cells from either the punctures or the cell block&#46; The cultures did not show germs&#44; and the polymerase chain reaction &#40;PCR&#41; and mycobacteria&#39;s culture were negatives&#46; Finally&#44; in cryoEBUS culture grows <span class="elsevierStyleItalic">M&#46; branderi</span> and patient was referred to infectious unit for assessment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; is the first case of atypical mycobacteria diagnosed by cryoEBUS&#46; CryoEBUS is a new and safe procedure&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> that could represent a promising technique in the study of intrathoracic lymphadenopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The overall diagnostic yield described is about 91&#46;8&#37; for cryoEBUS<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and seems more sensitive in uncommon tumours and benign disorders&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The poor tissue representation of EBUS-TBNA samples might restrict the diagnostic yield for certain conditions such as lymphoproliferative and granulomatous disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and cryobiopsy samples have demonstrated to be architecturally better preserved and bigger in size&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a> In our case&#44; EBUS-TBNA did not allow establishing the final diagnosis and definitive microbiological diagnosis was achieved by cryobiopsy&#46; Diagnostic yield for EBUS-TBNA in the diagnosis of mycobacterial diseases such as tuberculosis is around 80&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and cryoEBUS has been shown to significantly increase the efficacy to above 90&#37;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> but there are no references about non-tuberculous mycobacteria&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; cryoEBUS is a safe and feasible technique in expert units&#44; that offer a high diagnostic yield and could be a new option for infection diagnosis&#44; thereby improving the diagnostic strategy for non-malignant diseases&#46; More clinical studies are needed&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; Contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors have contributed substantially to obtaining the results and preparation of the manuscript&#44; according with ICMJE criteria&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare not to have any conflicts of interest that may be considered to influence directly or indirectly the content of the manuscript&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Artificial Intelligence Involvement</span><p id="par0045" class="elsevierStylePara elsevierViewall">Article was produced without the help of any artificial intelligence software or tool&#46;</p></span></span>"
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Clinical Letter
Mycobacterium branderi Diagnosed by CryoEBUS. A New Tool for Infection Diagnosis?
Albert Rafecas Codern, Virginia Pajares Ruiz, Pere Serra Mitjà
Corresponding author
pserramitja@gmail.com

Corresponding author.
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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    "titulo" => "<span class="elsevierStyleItalic">Mycobacterium branderi</span> Diagnosed by CryoEBUS&#46; A New Tool for Infection Diagnosis&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; is the technique of choice for the study of hilar and mediastinal lymph nodes&#44; useful in the study of lung cancer as well as in benign processes&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However&#44; diagnosis difficulties have been reported even in benign pathologies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Cryobiopsy of lymph nodes &#40;cryoEBUS&#41;&#44; a recent and promising technique&#44; improves the diagnostic yield of EBUS-TBNA up to 90&#37;&#44; with a good safety profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> Few cases of non-malignant disease as sarcoidosis or tuberculosis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> have been described&#46; We present a rare case of <span class="elsevierStyleItalic">Mycobacterium branderi</span> diagnosed by cryoEBUS&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 57-year-old male ex-smoker&#44; with human immunodeficiency virus &#40;HIV&#41; infection without active treatment by their own decision presented to a hospital because of weakness and weight loss&#46; Blood culture and virus test were negatives and chest X-ray showed no apparent lesions&#46; A cranial CT and lumbar puncture ruled out infection&#46; A positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; showed a hypermetabolic pulmonary nodule &#40;14<span class="elsevierStyleHsp" style=""></span>mm&#44; SUVmax 6&#46;76&#41; in left lower low &#40;LLL&#41; and enlarged mediastinal lymphadenopathies &#40;subcarinal 25<span class="elsevierStyleHsp" style=""></span>mm&#44; SUVmax 19&#46;03&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; EBUS-TBNA &#40;EB-1970UK&#44; Linear-Array&#59; Pentax Medical Company&#41; was performed under general anaesthesia by an anaesthesiologist using intravenous midazolam&#44; propofol and fentanyl&#46; With a 22-gauge needle &#40;ECHO-HD-22-EBUS-O&#44; Cook Medical Company&#41;&#44; we performed two punctures and obtained cytological samples and cell blocks&#44; evaluated by rapid on-site evaluation &#40;ROSE&#41;&#46; Then procedure with 22-gauge histological needle &#40;ECHO-HD-22-EBUS-O-C&#41;&#44; and after two punctures&#44; a cryoEBUS was performed in subcarinal region&#44; introducing a 1&#46;1<span class="elsevierStyleHsp" style=""></span>mm cryo-probe &#40;Erbecryo 20402-401&#44; Tubingen&#44; Germany&#41;&#44; obtaining three cryobiopsies &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The procedure was well tolerated and no complications were observed&#44; nor 72<span class="elsevierStyleHsp" style=""></span>h later&#46; Cytological studies showed lymphocytes without malignant cells from either the punctures or the cell block&#46; The cultures did not show germs&#44; and the polymerase chain reaction &#40;PCR&#41; and mycobacteria&#39;s culture were negatives&#46; Finally&#44; in cryoEBUS culture grows <span class="elsevierStyleItalic">M&#46; branderi</span> and patient was referred to infectious unit for assessment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; is the first case of atypical mycobacteria diagnosed by cryoEBUS&#46; CryoEBUS is a new and safe procedure&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> that could represent a promising technique in the study of intrathoracic lymphadenopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The overall diagnostic yield described is about 91&#46;8&#37; for cryoEBUS<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and seems more sensitive in uncommon tumours and benign disorders&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The poor tissue representation of EBUS-TBNA samples might restrict the diagnostic yield for certain conditions such as lymphoproliferative and granulomatous disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and cryobiopsy samples have demonstrated to be architecturally better preserved and bigger in size&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a> In our case&#44; EBUS-TBNA did not allow establishing the final diagnosis and definitive microbiological diagnosis was achieved by cryobiopsy&#46; Diagnostic yield for EBUS-TBNA in the diagnosis of mycobacterial diseases such as tuberculosis is around 80&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and cryoEBUS has been shown to significantly increase the efficacy to above 90&#37;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> but there are no references about non-tuberculous mycobacteria&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; cryoEBUS is a safe and feasible technique in expert units&#44; that offer a high diagnostic yield and could be a new option for infection diagnosis&#44; thereby improving the diagnostic strategy for non-malignant diseases&#46; More clinical studies are needed&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; Contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors have contributed substantially to obtaining the results and preparation of the manuscript&#44; according with ICMJE criteria&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare not to have any conflicts of interest that may be considered to influence directly or indirectly the content of the manuscript&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Artificial Intelligence Involvement</span><p id="par0045" class="elsevierStylePara elsevierViewall">Article was produced without the help of any artificial intelligence software or tool&#46;</p></span></span>"
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Article information
ISSN: 03002896
Original language: English
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