Radiographic progression despite microbiologic clearance in pulmonary Mycobacterium avium complex disease revealing concurrent lung adenocarcinomaa
- 1Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
Abstract
Background: Mycobacterium avium complex (MAC) pulmonary disease and lung adenocarcinoma can present with overlapping clinical and radiographic features, creating a significant diagnostic challenge. Radiographic progression during treatment of pulmonary MAC disease is often attributed to inadequate microbiologic response or persistent infection; however, this assumption may delay recognition of a concurrent malignancy, particularly when microbiologic parameters otherwise suggest an adequate treatment response.
Case presentation: A 78-year-old woman with bronchiectasis and previous microbiologic isolation of MAC was diagnosed with cavitary pulmonary MAC disease and initiated on guideline-directed multidrug therapy. Despite achieving sputum culture conversion, she developed new chest pain after approximately six months of treatment, and serial imaging demonstrated evolution of a previously cavitary right upper lobe lesion into a predominantly fluid-filled lesion with increasing surrounding consolidation. Bronchoscopy with biopsy revealed invasive pulmonary adenocarcinoma with coexisting necrotizing granulomatous inflammation. She subsequently underwent right upper lobectomy, with final pathology demonstrating a 6.5-cm poorly differentiated adenocarcinoma, negative surgical margins, and no lymph node metastases (pT3N0).
Conclusion: This case demonstrates that microbiologic culture conversion in pulmonary MAC disease should not preclude consideration of a concurrent malignant process when radiographic abnormalities continue to evolve. Discordance between microbiologic response and radiographic trajectory should prompt consideration of tissue diagnosis to exclude an underlying malignancy, potentially facilitating earlier diagnosis of lung cancer and preventing delays in definitive treatment.
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BibTeX
@article{kempanna2026radiographic,
title = {{Radiographic progression despite microbiologic clearance in pulmonary Mycobacterium avium complex disease revealing concurrent lung adenocarcinomaa}},
author = {Kavya Kempanna and Ramzia Muhammed Kunhi and Rutvi Shah and Justin M. Oring and Sangeeta Nair-Collins},
journal = {IDCases},
year = {2026},
month = oct,
doi = {10.1016/j.idcr.2026.e02798},
url = {https://doi.org/10.1016/j.idcr.2026.e02798},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Radiographic progression despite microbiologic clearance in pulmonary Mycobacterium avium complex disease revealing concurrent lung adenocarcinomaa
AU - Kavya Kempanna
AU - Ramzia Muhammed Kunhi
AU - Rutvi Shah
AU - Justin M. Oring
AU - Sangeeta Nair-Collins
PY - 2026
DA - 2026/10/14
JO - IDCases
DO - 10.1016/j.idcr.2026.e02798
UR - https://doi.org/10.1016/j.idcr.2026.e02798
AB - Background: Mycobacterium avium complex (MAC) pulmonary disease and lung adenocarcinoma can present with overlapping clinical and radiographic features, creating a significant diagnostic challenge. Radiographic progression during treatment of pulmonary MAC disease is often attributed to inadequate microbiologic response or persistent infection; however, this assumption may delay recognition of a concurrent malignancy, particularly when microbiologic parameters otherwise suggest an adequate treatment response. Case presentation: A 78-year-old woman with bronchiectasis and previous microbiologic isolation of MAC was diagnosed with cavitary pulmonary MAC disease and initiated on guideline-directed multidrug therapy. Despite achieving sputum culture conversion, she developed new chest pain after approximately six months of treatment, and serial imaging demonstrated evolution of a previously cavitary right upper lobe lesion into a predominantly fluid-filled lesion with increasing surrounding consolidation. Bronchoscopy with biopsy revealed invasive pulmonary adenocarcinoma with coexisting necrotizing granulomatous inflammation. She subsequently underwent right upper lobectomy, with final pathology demonstrating a 6.5-cm poorly differentiated adenocarcinoma, negative surgical margins, and no lymph node metastases (pT3N0). Conclusion: This case demonstrates that microbiologic culture conversion in pulmonary MAC disease should not preclude consideration of a concurrent malignant process when radiographic abnormalities continue to evolve. Discordance between microbiologic response and radiographic trajectory should prompt consideration of tissue diagnosis to exclude an underlying malignancy, potentially facilitating earlier diagnosis of lung cancer and preventing delays in definitive treatment.
SN - 2214-2509
ER -