CTICasesMycobacterium xenopi Pulmonary Infection with Chest Wall Invasion
Imaging findings
Chest radiographs and CT scans demonstrate a large, necrotic right apical mass with associated bone destruction of the adjacent upper ribs. Follow-up scans show progression of rib erosion and direct invasion of the adjacent chest wall musculature. FDG-PET/CT reveals a highly hypermetabolic apical lesion with a necrotic center. Biopsy and PCR testing confirmed the presence of Mycobacterium xenopi.
Key takeaways
Mycobacterium xenopi is an opportunistic, atypical mycobacterium that primarily affects immunocompromised hosts, such as patients on long-term immunosuppression for systemic lupus erythematosus (SLE) or those with pre-existing lung disease. Although local invasion of the chest wall and rib destruction are classic features of Actinomyces, Nocardia, or tuberculosis, atypical mycobacteria should be considered in the differential diagnosis of invasive apical thoracic masses in susceptible hosts.
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