The patient, a 63 year old female, was admitted to a nearby hospital with acute fever and severe cough.Her chest X-ray showed a solid shadow, indicating a foreign body in the right intermedius bronchus and a pneumonia shadow in the right lower lung field (Fig.1). The foreign body-which was proven to be her denture bridge-was removed, and the fever subsided.The patient has been ill and unconcious for 10 years following meningitis and cerebral atrophy.Therefore it is not known when the denture bridge was swallowed into the bronchus.But it is thought that the foreign body had been lodged there for at least 4 years.After removal of the foreign body, the pneumonia shadow on the chest X-ray film was much improved, but sputum examination showed frequent expectoration of acid-fast bacilli.The acid-fast bacilli were identified as
Mycobacterium scrofulaceum using the Atypical Mycobacterium Identification Kit (Kyokuto, Co., Tokyo, Japan) as shown in Table 3.Anti-tuberculous agents including SM, INH, and RFP, were administered.
The patient had no history of previous tuberculous infection.The chest X-ray films showed no abnormal foci indicative of tuberculosis.The tomogram showed bronchiectatic changes in the right lower bronchus (Fig.3). In this case, it is suspected that 1) a foreign body-the denture bridge-caused bronchiectasis of the right lower bronchus and then 2) atypical mycobacterial infection ocurred at this spot.Pulmonary.
Mycobacterium scrofulaceum infection is rare (0.7% of total atypical mycobacterial infections) in Japan.
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