case_images: PMC10576464_01
case_images: Chest X-ray and computed tomography of the upper, middle, and lower lungs, before the start of amikacin liposome inhalation suspension (ALIS) therapy (A-D), 3 weeks after ALIS initiation (E-H), and 9 weeks after the withdrawal of ALIS (I-L). Cavity wall (arrows) and bronchial wall (arrowhead) thinning was observed 3 weeks after starting ALIS treatment.
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case_images: PMC10576464_01_IDR-16-6629-g0001.jpg
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case_images: Chest X-ray and chest computed tomography on the first visit to our hospital showed that the patient had fibrocavitary-type pulmonary disease (Figure 1A-D). Chest X-ray and chest computed tomography revealed multiple infiltrative opacities in the left upper lobe and bilateral lower lobes (Figure 1E-H). ALIS had a high likelihood of being effective against M. intracellulare-pulmonary disease in this patient (Figure 1F and G). A nose swab polymerase-chain reaction test for coronavirus disease 2019 (COVID-19) was negative. Because these opacities worsened even after empiric antibiotic therapy featuring ceftriaxone for 5 days followed by tazobactam/piperacillin for 11 days, we started methylprednisolone (125 mg/day) based on a suspicion of DIILD caused by ALIS, and after 3 days, we observed signs of improvement and quickly tapered the steroid dose (Figure 1I-L).