case_images: PMC10891419_01
case_images: Chest radiography at the initial visit to our hospital of Case 1.. Chest radiography at the initial visit to our hospital showed an infiltrative shadow with an air bronchogram and bronchiectasis in the right middle and lower lung fields.
case_images: cureus-0016-00000052888-i01.jpg
case_images: PMC10891419_01_cureus-0016-00000052888-i01.jpg
case_images: FIG1
case_images: Chest radiography revealed an infiltrating shadow with an air bronchogram and bronchiectasis in the right middle and lower lung fields (Figure 1).
case_images: Chest computed tomography at the initial visit to our hospital of Case 1.. Chest computed tomography in early July 2018 (at the initial visit) to our hospital showed a cavity in the right S6 region (a) and bronchiectasis mainly in the right middle lobe (b).
case_images: cureus-0016-00000052888-i02.jpg
case_images: PMC10891419_01_cureus-0016-00000052888-i02.jpg
case_images: FIG2
case_images: Chest computed tomography (CT) revealed bronchiectasis mainly in the right middle lobe and a cavity in the right S6 region (Figure 2).
case_images: Progress of computed tomography of Case 1.. (a and b) Computed tomography (CT) in mid-January 2019 showed an enlarged cavity and worsening infiltrative shadow. (c and d) CT in mid-January 2020 showed a reduction in the cavity and an improvement in the infiltrative shadow. (e and f) CT in mid-March 2022 showed no sign of the re-expansion of the cavity or the reaggravation of the infiltrative shadow.
case_images: cureus-0016-00000052888-i03.jpg
case_images: PMC10891419_01_cureus-0016-00000052888-i03.jpg
case_images: FIG3
case_images: However, because chest CT showed worsening of the shadows (Figure 3a, 3b), treatment with clarithromycin (CAM), rifampicin (RFP), and ethambutol (EB) was initiated in mid-January 2019. After the initiation of treatment, the shadows on chest CT improved (Figure 3c, 3d), and the respiratory symptoms disappeared. The CT findings in March 2022 remained stable with no recurrence or progression (Figure 3e, 3f).
case_images: PMC10891419_02
case_images: Chest radiography at the initial visit to our hospital of Case 2.. Chest radiography at the initial visit to our hospital showed an infiltrating shadow in the right upper and lower lung fields.
case_images: cureus-0016-00000052888-i04.jpg
case_images: PMC10891419_02_cureus-0016-00000052888-i04.jpg
case_images: FIG4
case_images: Chest radiography revealed an infiltrating shadow in the right upper and lower lung fields (Figure 4).
case_images: Computed tomography at the initial visit to our hospital of Case 2.. Computed tomography (CT) showed an infiltrative shadow and bronchiectasis in the right upper (a) and middle lobes and lobular central granular shadows in both lower lobes (b).
case_images: cureus-0016-00000052888-i05.jpg
case_images: PMC10891419_02_cureus-0016-00000052888-i05.jpg
case_images: FIG5
case_images: Chest CT showed an infiltrative shadow and bronchiectasis in the right upper and middle lobes and lobular central granular shadows in both lower lobes (Figure 5).
case_images: Progress of computed tomography of Case 2.. (a) Computed tomography (CT) in mid-February 2023 showed no improvement of lobular central granular shadows in both lower lobes. (b) CT in early October 2023 showed the improvement of lobular central granular shadows in both lower lobes.
case_images: cureus-0016-00000052888-i06.jpg
case_images: PMC10891419_02_cureus-0016-00000052888-i06.jpg
case_images: FIG6
case_images: However, because the structural destruction of the lungs had already progressed and CT showed no improvement in the shadows (Figure 6a), treatment with CMA, RFP, and EB was initiated in early February 2023. The lobular central granular shadows in both lower lobes have improved since the start of treatment (Figure 6b), and at the time of the writing of this report, treatment has been ongoing for 10 months and will continue in the future.