Hemoptysis requiring bronchial artery embolization in patients with nontuberculous mycobacterial lung disease
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RESEARCH ARTICLE
Open Access
Hemoptysis requiring bronchial artery embolization in patients with nontuberculous mycobacterial lung disease Su Hwan Lee1 , Jin Hwa Lee2 , Jung Hyun Chang2 , Soo Jung Kim2 , Hee-Young Yoon2 , Sung Shine Shim3 , Min Uk Kim4 , Sun Young Choi3 and Yon Ju Ryu2*
Abstract Background: Although infections caused by nontuberculous mycobacteria (NTM) are increasing in prevalence, there are few data about hemoptysis in patients with NTM lung disease. This study investigated the characteristics and prognosis of hemoptysis secondary to NTM infection. Methods: Following a retrospective review of cases managed between 2006 and 2016, 183 patients with NTM lung disease were enrolled and analyzed. Results: Among 183 patients with NTM lung disease, Mycobacterium intracellulare (n = 64, 35%) was the major cause of NTM infection, followed by M. avium (n = 59, 32.2%) and M. abscessus complex (n = 40, 21.9%). Hemoptysis developed in 78 patients (42.6%), among whom 33 (42.3%) required bronchial artery embolization (BAE). Between patients with and without hemoptysis, there were no significant differences with respect to sex, radiographic manifestations, distribution over 3 lobes on chest computed tomography, history of pulmonary tuberculosis, antiplatelet or anticoagulation therapy, and species of NTM. However, mean age at diagnosis was significantly lower in the hemoptysis group in univariate and multivariate analyses (65.7 ± 12.8 vs. 59.7 ± 11.8, P = 0.002, odds ratio: 0.969, 95% confidence interval: 0.944–0.996). Among patients with hemoptysis, those requiring medical therapy and those requiring BAE were not significantly different in terms of demographic characteristics, radiographic manifestations, and distribution over 3 lobes. All patients who received BAE showed immediate clinical improvement, no procedure-related complications, and none of them died during the period under review. Conclusions: NTM lung disease patients commonly experienced hemoptysis without specific risk factors except for relatively young age. Although some patients with hemoptysis needed BAE, the success rate of BAE was high, and there were no serious complications associated with BAE. Keywords: Mycobacterium infections, nontuberculous, Tuberculosis, Hemoptysis, Embolization, therapeutic
Background The prevalence of human infection with nontuberculous mycobacteria (NTM), an emerging cause of chronic pulmonary disease, is gradually increasing worldwide [1, 2]. Most NTM have low pathogenicity, and they are widely distributed in natural environments, such as soil and water sources [3]. It is difficult to distinguish among * Correspondence: [email protected] 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea Full list of author information is available at the end of the article
NTM colonization, contamination, and infection. The American Thoracic Society (ATS) and the Infectious Disease S
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