Long-term good outcome of the fibrocavitary form of pulmonary Mycobacterium avium complex disease with concomitant abatacept monotherapy in a patient with rheumatoid arthritis.
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| Abstract |
A 53-year-old woman diagnosed with rheumatoid arthritis (RA) demonstrated thick-walled large cavities with consolidation in the left upper lobe on chest computed tomography (CT). Mycobacterium avium was isolated from sputum cultures, and she was diagnosed as having the fibrocavitary (FC) form of pulmonary Mycobacterium avium complex (MAC) disease. Clarithromycin-containing, multidrug, anti-MAC chemotherapy was started immediately. After 7 months, the cavitary lesions improved, and sputum cultures showed negative conversion. Thereafter, abatacept monotherapy was started due to high RA disease activity. Clinical remission of RA has been sustained and cavitary lesions disappeared by concomitant abatacept and anti-MAC therapy for more than 5 years. Immediate initiation of anti-MAC therapy and prior confirmed efficacy are needed for the treatment of the FC form. Abatacept and anti-MAC therapy could be continued, leading to the withdrawal of prednisolone, along with careful observation by strict chest CT evaluation and repeated sputum cultures. Biologics are generally contraindicated for pulmonary MAC disease, particularly the FC form. When there is a pre-existing lung lesion apparently of FC type, abatacept cannot be started without prior anti-MAC chemotherapy. This case suggests that abatacept may be carefully used to avoid progressive joint destruction after FC lesions of pulmonary MAC disease are resolved.
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| Authors | Shogo Banno, Etsuro Yamaguchi, Shiho Iwagaitsu, Hironobu Nobata, Makoto Yamaguchi, Hirokazu Sugiyama, Hiroshi Kinashi, Takayuki Katsuno, Akihito Kubo, Satoru Ito, Yasuhiko Ito |
| Journal | Modern rheumatology case reports (Mod Rheumatol Case Rep) Vol. 6 Issue 1 Pg. 1-5 (01 07 2022) ISSN: 2472-5625 [Electronic] England |
| PMID | 34637523 (Publication Type: Case Reports, Journal Article) |
| Copyright | © Japan College of Rheumatology 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]. |
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