Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (3)

Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (3)The patient was begun on a regimen of antituberculosis therapy for presumed extrapulmonary tuberculosis, but the patient remained persistently febrile and showed no clinical improvement. Three weeks following the bronchoscopy, blood cultures, bronchoalveolar lavage fluid, transbronchial biopsy specimens, and sputa all grew MAI. Despite the addition of numerous antimycobacterial agents, the patient remained clinically unchanged and was subsequently discharged from the hospital on a regimen of only AZT and aerosolized pentamidine.

Discussion
Mycobacterial disease has been found to be common in patients infected with HIV often presenting as extrapul-monary or disseminated disease. Although intrathoracic mediastinal lymphadenopathy is more usually found in HIV-associated Mycobacterium tuberculosis, the finding of MAI in mediastinal nodes has been observed. Given the rising number of cases of tuberculosis being reported and its strong association with HIV infection, it can be expected that increasing numbers of HIV-infected patients with mediastinal mycobacterial lymphadenopathy will be seen. In this light, the potential application of TBNA for diagnosing mycobacterial mediastinal lymphadenopathy can be appreciated.

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