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When the anchor was right: imaging, histopathology, ecological rationality, and the diagnosis of culture-negative nontuberculous mycobacterial lung disease| Rassegna di Patologia dell'Apparato Respiratorio
V. 40: Fascicolo 4 - Dicembre 2025
Pulmonology FM
Pubblicato: 2026-07-30
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When the anchor was right: imaging, histopathology, ecological rationality, and the diagnosis of culture-negative nontuberculous mycobacterial lung disease

DIMEC, University of Bologna, Bologna; Department of Medical Specialities/Pulmonology Unit, Ospedale GB Morgagni/University of Bologna, Forlì (FC); Department of Respiratory Medicine & Allergy, Aarhus University, Aarhus (DK)
Outpatient Respiratory Service, ASSL Ogliastra, Tortolì (NU)
Department of Medical Specialities/Pulmonology Unit, Ospedale GB Morgagni/University of Bologna, Forlì (FC)
DIMEC, University of Bologna, Bologna; Department of Radiology, Ospedale GB Morgagni/University of Bologna, Forlì (FC)

Abstract

  • 18- YEAR-OLD MALE, NEVER SMOKER, NO KNOWN ALLERGIES
  •   STUDENT
  •   NO DRUG ABUSE HISTORY
  •   FAMILIAL CLINICAL HISTORY: not relevant
  •   ASSOCIATED MEDICAL CONDITIONS: ADHD
  •   PAST MEDICAL HISTORY: previous hospital admission for lung abscess at age of eleven, followed by subsequent hospital admission for pneumonia four years later
  •   PHARMACOLOGICAL THERAPY: none
  •   CLINICAL ONSET: subacute onset with fever and right lower lobe consolidation unresponsive to antibiotic and antifungal therapy

The patient was admitted to Pulmonology Department because of persistent, antibiotic resistant, right lower lobe consolidation associated with right pleural effusion. During a previous hospitalization, he had already undergone fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy: both were negative for bacteria, fungi, mycobacteria, and non-tuberculous mycobacteria (NTM). Histopathological examination of the transbronchial biopsy was non-diagnostic.

Upon admission, blood tests and microbiological investigations were repeated.

Laboratory tests revealed mild neutrophilic leukocytosis and a marked elevation in C-reactive protein (CRP), without significant rise in procalcitonin levels. Liver and renal function tests were within normal limits. Analysis of lymphocyte subsets and immunoglobulin classes revealed no evidence of immunodeficiency. A comprehensive autoimmune panel was also negative.

Affiliazioni

Venerino Poletti

DIMEC, University of Bologna, Bologna; Department of Medical Specialities/Pulmonology Unit, Ospedale GB Morgagni/University of Bologna, Forlì (FC); Department of Respiratory Medicine & Allergy, Aarhus University, Aarhus (DK)

Cristina Pavano

Outpatient Respiratory Service, ASSL Ogliastra, Tortolì (NU)

Stefano Oldani

Department of Medical Specialities/Pulmonology Unit, Ospedale GB Morgagni/University of Bologna, Forlì (FC)

Sara Piciucchi

DIMEC, University of Bologna, Bologna; Department of Radiology, Ospedale GB Morgagni/University of Bologna, Forlì (FC)

Licenza

Creative Commons License

Questo lavoro è fornito con la licenza Creative Commons Attribuzione - Non commerciale - Non opere derivate 4.0 Internazionale.

Copyright

© Associazione Italiana Pneumologi Ospedalieri – Italian Thoracic Society (AIPO – ITS) , 2026

Come citare

Poletti, V., Pavano, C., Oldani, S., & Piciucchi, S. (2026). When the anchor was right: imaging, histopathology, ecological rationality, and the diagnosis of culture-negative nontuberculous mycobacterial lung disease. Rassegna Di Patologia dell’Apparato Respiratorio, 40(4). Recuperato da https://www.aiporassegna.it/article/view/854
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