Chronic thromboembolic pulmonary hypertension and idiopathic pulmonary hypertension are the conditions predisposing to non-tuberculous mycobacterial lung disease (NTMLD)

Abstract

Non-tuberculous mycobacterial lung disease (NTMLD) is a rare disorder diagnosed in 0.6-1.8/100,000 people. Nevertheless NTMLD may be observed more frequently (2-6%) in the patients (pts) with predisposing conditions such as chronic lung diseases (COPD, cystic fibrosis), genetic disorders and many others. The aim of the present study was to assess the frequency and clinical features of NTMLD in CTEPH and IPAH pts. 250 patients (150 with CTEPH and 100 with IPAH) diagnosed and treated in the Department of Chest Medicine, National Institute of Tuberculosis and Lung Diseases in the period of 2002-2008 entered the study. NTMLD fulfilling the criteria of ATS 2007, was diagnosed in 9 pts (3.6%): 6 pts with CTEPH (4%) and 3 with IPAH (3%). Majority of patients presented with exacerbation of dyspnea. Chest CT scans revealed areas of infiltration with cavitation, surrounded by small nodules in 4/9 pts, cavities surrounded by small nodules in 4/9 and cavities only in 1 pt. NTMLD-related lung pathology developed in the areas with hypoperfusion, no parenchymal lung pathology was seen on CT scans taken before the disease development. The responsible pathogen was M. kansasii in all of the patients. NTMLD was observed more frequently in CTEPH and IPAH patients with BMI<25, with low cardiac output (CO) and low mixed venous blood saturation (satO2mv).

Conclusion: CTEPH and IPAH are probably the diseases predisposing to NTMLD. The disease develops in the hypoperfused regions of lung parenchyma, in the patients with low CO and satO2mv.