
==== Front
Intern Med
Intern Med
Internal Medicine
0918-2918
1349-7235
The Japanese Society of Internal Medicine

38171854
10.2169/internalmedicine.2627-23
Pictures in Clinical Medicine
Pulmonary Mycobacterium shinjukuense Infection with a Nodular Bronchiectatic Pattern
Sunanaga Shima 1
Sunanaga Yusuke 2
1 National Hospital Organization Minamikyushu Hospital, Japan
2 Nagai Hospital, Japan
Correspondence to Dr.　Shima Sunanaga, sssygoto@gmail.com

2 1 2024
15 8 2024
63 16 23492350
17 7 2023
19 11 2023
Copyright © 2024 by The Japanese Society of Internal Medicine
https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Mycobacterium shinjukuense
fibrocavity pattern
nodular bronchiectatic pattern
==== Body
pmcA 55-year-old woman with a history of pulmonary tuberculosis presented to our hospital with a productive cough for 1 month. The patient had no fever or bloody sputum. Chest radiography revealed infiltration in the left lung field (Picture 1). Computed tomography showed bronchiectasis and nodular opacity in the lingular segment and the left lower lobe (Picture 2). Bronchial lavage fluid mycobacterium smears and culture results were positive. Mycobacterium tuberculosis and M. avium complex (MAC) polymerase chain reaction tests were negative; therefore, additional identification tests (rpoB and 16S rRNA gene sequencing) were performed. The homologies of the DNA sequence between the strains and M. shinjukuense for the 16S rRNA and rpoB genes were 100% and 100%, respectively. A diagnosis of pulmonary M. shinjukuense infection was thus made. In previously reported cases, most pulmonary M. shinjukuense infection patients with a history of pulmonary tuberculosis presented a fibrocavity pattern on imaging (1). In nodular bronchiectatic patterns in patients with a history of pulmonary tuberculosis, as in this case, M. shinjukuense infection should be considered in addition to recurrent tuberculosis and MAC infection. A daily regimen of three-drug combination therapy (clarithromycin, rifampicin, and ethambutol) was initiated. One month later, sputum Mycobacterium smears and cultures, which had been positive at the diagnosis, turned negative and remained negative thereafter. Symptoms and imaging findings also improved (Picture 3).

Picture 1.

Picture 2.

Picture 3.

The authors state that they have no Conflict of Interest (COI).
==== Refs
1. Takeda K , Ohshima N , Nagai H , et al . Six cases of pulmonary Mycobacterium shinjukuense infection at a single hospital. Intern Med 55 : 787-791, 2016.27041166
