Scientific Letter
Mycobacterium xenopi and Squamous Cell Carcinoma of the Lung
Mycobacterium xenopi y carcinoma pulmonar de células escamosas
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"identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium xenopi</span> y carcinoma pulmonar de células escamosas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1587 "Ancho" => 2500 "Tamanyo" => 238097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal CT with lung window: cavitating mass with thick irregular wall, 18<span class="elsevierStyleHsp" style=""></span>mm in the left upper lobe extending toward the mediastinum. (B) Axial PET-CT: mass showing high uptake of fluorodeoxyglucose, with a standard uptake value of 28.38 units.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-tuberculous mycobacteria (NTM) or atypical mycobacteria are aerobic bacteria of the genus <span class="elsevierStyleItalic">Mycobacterium</span>, the pathogenic potential of which has been known since the 1950s.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> The AIDS pandemic, the progressive increase in immunosuppressive states, and the improvement of microbiological techniques have made isolation of these microorganisms more common nowadays.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mycobacterium xenopi (M. xenopi)</span> is a NTM associated with water systems that is found primarily in North America, the south east of Great Britain, and the north of France,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> and was first isolated in immunosuppressed patients. The main risk factors for the disease are chronic lung diseases, during which the organism can colonize the respiratory tract.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Cases of mycobacterial infection have been published in cancer patients,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> but cases involving <span class="elsevierStyleItalic">M. xenopi</span> are exceptional. No references to the subject were found in articles retrieved from a literature for articles published in Spanish using the standard search engines, Medline and Pubmed (key words: <span class="elsevierStyleItalic">Mycobacterium xenopi</span> and <span class="elsevierStyleItalic">lung cancer</span>). We report a case of <span class="elsevierStyleItalic">M. xenopi</span> infection in a patient with severe COPD and a diagnosis of squamous cell carcinoma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This was a 73-year-old man, active smoker, diagnosed with severe COPD in 2006. He consulted for asthenia, epigastric pain, weight loss, and productive cough without fever. The only relevant finding on physical examination was poor nutritional status. Clinical laboratory test results showed normochromic normocytic anemia (hemoglobin 10.8<span class="elsevierStyleHsp" style=""></span>g/dl), with ESR 46<span class="elsevierStyleHsp" style=""></span>mm and ferritin 9.4<span class="elsevierStyleHsp" style=""></span>ng/ml (normal value: 30–400<span class="elsevierStyleHsp" style=""></span>ng/ml). Chest radiograph revealed an infiltrate in the left upper lobe (LUL), disperse granulomas, and bilateral air trapping. Gastrointestinal endoscopy showed <span class="elsevierStyleItalic">Candida</span> esophagitis, erosive duodenitis with a negative urease test, and diverticula in the colon. Acid-fast bacilli were observed in 3 sputum samples, so treatment was initiated with isoniazid, rifampicin, pyrazinamide, and ethambutol, in addition to oral iron and fluconazole. After culture of 3 sputum samples in Löwenstein medium grew <span class="elsevierStyleItalic">M. xenopi</span>, the antimicrobial therapy was adjusted, and treatment began with clarithromycin, rifampicin, and ethambutol.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Chest computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) confirmed the existence of a solid lesion with a spiculated border and central cavitation in the LUL, measuring 40×35<span class="elsevierStyleHsp" style=""></span>mm, with an 18<span class="elsevierStyleHsp" style=""></span>mm-thick wall, contiguous with another paramediastinal lesion measuring 3<span class="elsevierStyleHsp" style=""></span>cm, signs of emphysema and multiple calcified granulomas. No endoluminal lesions or changes in the mucosa were seen on bronchoscopy. PET-CT confirmed a hypermetabolic mass in the left lung apex, with the appearance of a malignant lung tumor. Transbronchial biopsy yielded a diagnosis of squamous cell carcinoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. xenopi</span> infections usually occur with nonspecific symptoms such as dyspnea, cough, and weight loss,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> and primarily affect males with COPD.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7,8</span></a> Radiological changes are wide-ranging and usually persistent. Cavitating lesions in the upper lobes, masses, miliary nodules, and mediastinal or hilar adenopathies are common.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> Woodring and Fried<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> found that the majority of cavities larger than 15<span class="elsevierStyleHsp" style=""></span>mm in diameter were, as in our case, tumor disease. To our knowledge, 3 cases of <span class="elsevierStyleItalic">M. xenopi</span> infection associated with lung cancer have been published: adenocarcinoma,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> large cell carcinoma,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> and squamous cell carcinoma,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> none of which presented the 2 entities simultaneously, as observed in our case.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To diagnose these diseases, mycobacteria must be grown in 3 sputum cultures, and clinical and radiological evidence must be consistent.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> The best therapeutic combination and optimal treatment duration for <span class="elsevierStyleItalic">M. xenopi</span> lung infections remain to be determined. According to current criteria for NTM infection (ATS/IDSA 2007),<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> a 12-month course of a combination of rifampicin, ethambutol, and clarithromycin (or moxifloxacin, due to its low inhibitory concentration against mycobacteria<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>) is recommended.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">M. xenopi</span> infection is exceptional, we believe that this case illustrates the importance of ruling out NTM infection in the case of co-existing symptoms or nonspecific signs such as weight loss or anemia in patients with COPD and lung cancer.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín Asenjo M, Martín Guerra JM, López Pedreira MR, Prieto de Paula JM. <span class="elsevierStyleItalic">Mycobacterium xenopi</span> y carcinoma pulmonar de células escamosas. Arch Bronconeumol. 2017;53:698–700.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1587 "Ancho" => 2500 "Tamanyo" => 238097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal CT with lung window: cavitating mass with thick irregular wall, 18<span class="elsevierStyleHsp" style=""></span>mm in the left upper lobe extending toward the mediastinum. (B) Axial PET-CT: mass showing high uptake of fluorodeoxyglucose, with a standard uptake value of 28.38 units.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary infection with <span class="elsevierStyleItalic">Mycobacterium xenopi</span>: review of treatment and response" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Banks" 1 => "A.M. Hunter" 2 => "I.A. Campbell" 3 => "P.A. Jenkins" 4 => "A.P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 53 | 18 | 71 |
| 2024 September | 56 | 17 | 73 |
| 2024 August | 83 | 41 | 124 |
| 2024 July | 66 | 32 | 98 |
| 2024 June | 74 | 42 | 116 |
| 2024 May | 105 | 33 | 138 |
| 2024 April | 45 | 43 | 88 |
| 2024 March | 59 | 19 | 78 |
| 2024 February | 56 | 24 | 80 |
| 2023 March | 13 | 2 | 15 |
| 2023 February | 61 | 24 | 85 |
| 2023 January | 50 | 39 | 89 |
| 2022 December | 86 | 50 | 136 |
| 2022 November | 55 | 22 | 77 |
| 2022 October | 79 | 37 | 116 |
| 2022 September | 59 | 31 | 90 |
| 2022 August | 47 | 45 | 92 |
| 2022 July | 52 | 43 | 95 |
| 2022 June | 46 | 44 | 90 |
| 2022 May | 53 | 35 | 88 |
| 2022 April | 60 | 44 | 104 |
| 2022 March | 37 | 41 | 78 |
| 2022 February | 47 | 32 | 79 |
| 2022 January | 70 | 39 | 109 |
| 2021 December | 40 | 47 | 87 |
| 2021 November | 60 | 37 | 97 |
| 2021 October | 56 | 53 | 109 |
| 2021 September | 50 | 43 | 93 |
| 2021 August | 34 | 35 | 69 |
| 2021 July | 43 | 35 | 78 |
| 2021 June | 45 | 35 | 80 |
| 2021 May | 49 | 47 | 96 |
| 2021 April | 161 | 105 | 266 |
| 2021 March | 57 | 12 | 69 |
| 2021 February | 58 | 20 | 78 |
| 2021 January | 36 | 10 | 46 |
| 2020 December | 43 | 15 | 58 |
| 2020 November | 58 | 16 | 74 |
| 2020 October | 56 | 18 | 74 |
| 2020 September | 28 | 14 | 42 |
| 2020 August | 34 | 20 | 54 |
| 2020 July | 34 | 30 | 64 |
| 2020 June | 43 | 18 | 61 |
| 2020 May | 59 | 13 | 72 |
| 2020 April | 50 | 20 | 70 |
| 2020 March | 41 | 18 | 59 |
| 2020 February | 49 | 22 | 71 |
| 2020 January | 54 | 16 | 70 |
| 2019 December | 43 | 12 | 55 |
| 2019 November | 41 | 20 | 61 |
| 2019 October | 34 | 15 | 49 |
| 2019 September | 108 | 18 | 126 |
| 2019 August | 48 | 25 | 73 |
| 2019 July | 28 | 18 | 46 |
| 2019 June | 31 | 18 | 49 |
| 2019 May | 57 | 13 | 70 |
| 2019 April | 74 | 21 | 95 |
| 2019 March | 58 | 19 | 77 |
| 2019 February | 33 | 16 | 49 |
| 2019 January | 42 | 29 | 71 |
| 2018 December | 61 | 25 | 86 |
| 2018 November | 101 | 31 | 132 |
| 2018 October | 92 | 26 | 118 |
| 2018 September | 45 | 15 | 60 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 40 | 13 | 53 |
| 2018 March | 47 | 12 | 59 |
| 2018 January | 1 | 0 | 1 |
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