Abstract
A 25-year-old, male machinary worker was hospitalized in October 1969 complaining of hemoptysis. Acid-fast organism was not found in smear of sputum but showed by culture three times (1, 3 and 3 colonies, respectively) in the month hospitalized. 10 colonies of acid-fast organism were seen in November 1969 and thereafter no organism was seen until discharge in April 1973. The organism was identified as M. chelonei subsp. chelonei. The patient showed fibrocaseous lesion in the right upper lobe. The lesion improved slightly but remained at a considerable amount even after administration of various antituberculous drugs. In May 1972, the patient received resection of right upper lobe. The resected lung contained two encapsulated, caseous lesions with many small tubercles. From the lesion, 4 colonies of M. chelonei subsp. chelonei were isolated. Other acid-fast organism was not isolated. The pathological diagnosis was tuberculosis of lung. This was because that the lesions caused by this organism were the same findings as tuberculosis.
Clinical feature of lung infection caused by this organism has been presented by Tsukamura et al. (1973) based on the clinical findings of 9 cases. The case shown in the present study is the 10th. In view of these 10 cases, clinical feature of the infection caused by this organism is considered as follows: (1) initial symptome is often hemoptysis (6 out of 10); (2) excertion of the organism in sputum is scanty or absent; hence, definite diagnosis is made by proving the organism from resected lung; (3) the extent of lesion is limited to a lobe or at most two lobes; (4) chemotherapy is usually not so effective; (5) prognosis is usually good.
The reason for scanty excretion of the organism in sputum has been discussed.
