J Korean Med Sci.  2023 Jan;38(3):e16. 10.3346/jkms.2023.38.e16.

Radiologic Subtypes and Treatment Outcome of Unclassifiable Type Mycobacterium avium Complex Pulmonary Disease

• Lee JH
• Park YE
• Chong YP
• Lee HJ
• Shim TS
• Jo KW

• KMID: 2538371
• DOI: http://doi.org/10.3346/jkms.2023.38.e16

Abstract

Background: Although the “unclassifiable type” is categorized as one of the radiologic classifications in Mycobacterium avium complex (MAC) pulmonary disease (PD), there have been few studies of this type thus far. We aimed to investigate the radiologic subtypes and treatment outcome of unclassifiable type MAC-PD.
Methods
Ninety-six patients with unclassifiable type MAC-PD who initiated a macrolidecontaining regimen from 2001 to 2020 were identified at a tertiary referral center in South Korea. Among these 96 patients, 1-year culture conversion rate was analyzed for 48 patients who received standard treatment (three-drug oral-antibiotic combination with or without an injectable agent) for ≥ 1 year.
Results
The mean age of the 96 patients was 65.4 ± 10.8 years, and 72.9% of them were male. These patients were classified into four major radiologic subtypes; the most common subtype was the focal cavity subtype (n = 31, 32.3%), followed by the focal mass or nodule (n = 23, 24.0%), consolidation upon emphysema (n = 21, 21.9%), and bronchiolitis (n = 21, 21.9%) subtypes. For the 48 patients who received standard treatment for ≥ 1 year, the overall rate of culture conversion at 1-year was 93.8%. All patients in the focal cavity subtype and focal mass or nodule subtype categories achieved 1-year culture conversion. Additionally, 1-year culture conversion rate was 92.9% in consolidation upon emphysema subtype and 75.0% in bronchiolitis subtype.
Conclusion
Unclassifiable type MAC-PD can be radiologically further categorized into four major radiologic subtypes. The treatment outcome of all of these subtypes seems to be favorable.

Keyword

Mycobacterium avium complex ; Unclassifiable Type; Subtype; Treatment Outcome

Figure

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  Fig. 1 Study flow chart of radiologic subtype analysis.MAC = Mycobacterium avium complex.aIncluded fibrocavitary, cavitary nodular bronchiectatic, and non-cavitary nodular bronchiectatic type.bMinor types included the radiologic findings of non-specific infiltrative lesion in the underlying tuberculous destroyed lung (n = 6), ground glass opacity (n = 3), nodules without tree-in-bud (n = 2), non-specific infiltrative lesion in underlying bronchiolitis obliterans (n = 2), disseminated nodular lesion (n = 1), acute respiratory distress syndrome (n = 1), and other types (n = 2).

• 

  Fig. 2 Representative chest CT images of the four major radiologic subtypes of the unclassifiable type in the present study. (A) Chest CT of 53-year-old women showing an approximately 2-cm-sized thin-walled focal cavitary lesion in the right upper lobe. (B) Irregular-shaped thick-walled cavitary lesion of 4.2 × 3.7 cm in size was noted in the right lower lobe with adjacent multiple small nodular and branching linear-shaped parenchymal opacities in the chest CT of 35-year-old women. (C) CT scan of a 55-year-old man showing a focal consolidative nodular lesion with internal necrotic changes in the right upper lobe. (D) Irregular-shaped consolidative mass lesion in the left lower lobe was seen in the chest CT of 50-year-old women. (E) Newly developed infiltrative consolidation was noted in the left upper lobe in a 73-year-old male patient who had underlying diffuse centrilobular emphysema. (F) Chest CT scan of a 75-year-old male patient with centrilobular emphysema as a underlying disease showed consolidative infiltration in the right upper lobe. (G) Centrilobular nodules with tree-in-bud appearance was noted with focal bronchiectatic changes in the right lower lobe in the chest CT scan of a 62-year-old male patient. (H) Chest CT scan of a 79-year-old female patient showed a segmentally distributed centrilobular nodule with the tree-in-bud sign was seen in right upper lobe.CT = computed tomography.

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  Fig. 3 Study flow chart of treatment outcome analysis.EMB = ethambutol, MAC = Mycobacterium avium complex, RIF = rifampin.

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