Non-tuberculous mycobacterial lung disease due to multiple “minor” risk factors: an illustrative case and a review of these “lesser elements”
Abstract
Gastroesophageal reflux (GER) was also present for many years with the patient preferring to sleep on her left side with no head-of-bed elevation.Family history is notable for father with lung cancer and a maternal grandfather with pulmonary tuberculosis.She is a never smoker and drinks half a glass of wine a day.She has a horse that she visits on a farm with consequent exposures to soil and dust.Medications included levothyroxine, dexlansoprazole, zolpidem, celecoxib, and various over-the-counter vitamins, minerals, and supplements.On examination, the temperature is 36.9℃, heart rate 82 per minute, blood pressure 123/62 mmHg, respiratory rate 18 per minute, SpO 2 98% on room air, and body mass index (BMI) of 19 kg/m 2 .Physical examination is unremarkable with normal breath sounds.The complete blood count, electrolytes, renal and hepatic functions, immunoglobulin levels, IgG subclass levels, and antibody responses to diphtheria, tetanus and pneumococcus are within normal limits.The blood T and B cell subsets, natural killer cell function, and interferon gamma (IFNγ) level are also normal.The cystic fibrosis conductance regulator (CFTR) genotype is heterozygous for delta F508.The AAT protease inhibitor (Pi) phenotype is PiMS and the level is 106 mg/dL (normal range, 72 to
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