Mycobacterium Avium Complex Pneumonia Masquerading as a Lung Mass with Broncho-Pleural Fistula and Empyema in an Immunocompetent Patient-A Case Study

This chapter present the clinical, laboratory, radiological features, and management of MAC empyema in an elderly patient. The study also provides a brief overview of cases of MAC associated pleurisy and empyema that have been reported in literature. Non-tuberculous mycobacteria (NTM) called Mycobacterium avium complex (MAC) is known to produce cavitary or fibro-cavitary pneumonia and subacute or chronic nodular bronchiectasis in individuals with chronic structural lung pathology, such as emphysema, chronic bronchitis, and bronchiectasis. Additionally, it is an etiological agent linked to disseminated infections and extrapulmonary infections in immunocompromised individuals, including transplant recipients, as well as acquired immune deficiency syndrome (AIDS). Empyema brought on by MAC is an uncommon occurrence that is seldom ever documented in the media. We report about a 72 yrs. old caucasian male with past medical history of chronic obstructive pulmonary disease (COPD), atrial fibrillation, gastroesophageal reflux disease, arterio-venous malformation of ascending colon, abdominal aortic aneurysm, stable left lower lobe lung mass (noticed on imaging 2 years ago) was admitted with chief complaints of progressively worsening shortness of breath associated with left sided pleuritic chest pain and productive cough with yellowish sputum for 2-3 weeks. Later in his course, he presented to us with a large mass and pleural effusion complicated by a bronchopleural fistula, that was diagnosed as MAC empyema. To our knowledge, this is the first case of MAC empyema, that presented as a chronic lung mass, complicated by a bronchopleural fistula and empyema. High clinical suspicion, suitable NTM tests, and prompt medical and surgical therapies are essential for effective therapy that would lower morbidity and death.