2025 年第 3 期 第 20 卷

胞内分枝杆菌肺病后鸟分枝杆菌感染合并多发性骨质破坏1例

A case of Mycobacterium avium infection complicated with multiple bone destruction after Mycobacterium intracellulare pulmonary disease

作者：李少宁李慧媛周向东林秀山刘畅

英文作者：Li Shaoning Li Huiyuan Zhou Xiangdong Lin Xiushan Liu Chang

单位：海南医科大学第一附属医院呼吸内科，海口570000

英文单位：Department of Respiratory Medicine The First Affiliated Hospital of Hainan Medical University Haikou 570000 China

关键词：胞内分枝杆菌肺病；鸟分枝杆菌；骨破坏

英文关键词：Mycobacteriumintracellularepulmonarydisease;Mycobacteriumavium;Bonedestruction

• 摘要：

• 分析2025年7月29日在海南医科大学第一附属医院经骨髓宏基因组二代测序检测确诊的1例反复发热的鸟分枝杆菌感染合并多发性骨质破坏患者的临床资料，并进行文献复习。患者为58岁女性，因“发热2个月余”，既往曾因发热于我科住院，行气管镜留取肺泡灌洗液发现胞内分枝杆菌，经抗非结核分枝杆菌治疗后无发热，半年后患者反复发热，此次因发热较前加重再次入院，且反复出现白细胞计数升高明显，但入院胸部CT提示病灶较前吸收，全身骨扫描出现全身多发骨质破坏，行骨髓穿刺活检后发现鸟分枝杆菌及病毒感染，再次予抗非结核及抗病毒治疗，经治疗后无发热。针对非结核分枝杆菌肺病感染后，当肺部病灶吸收而出现全身骨质破坏时不可忽视其他非结核分枝杆菌感染合并骨质破坏的可能。

• The clinical data of a patient with recurrent fever, diagnosed with Mycobacterium avium infection complicated with multiple bone destruction via bone marrow metagenomic next-generation sequencing at The First Affiliated Hospital of Hainan Medical University on July 29, 2025, were analyzed, and a literature review was conducted. The patient was a 58-year-old female admitted due to "fever for more than 2 months". She had been previously hospitalized in our department for fever; Mycobacterium intracellulare was detected in the alveolar lavage fluid collected via bronchoscope, and fever subsided after anti-nontuberculous mycobacterium treatment. Half a year later, the patient developed recurrent fever, and was re-admitted due to aggravated fever. She also had repeated significant elevation of white blood cell count, but chest CT on admission showed resolution of lesions compared with previous findings. Whole-body bone scan revealed multiple bone destruction throughout the body. Bone marrow aspiration biopsy was performed, which detected Mycobacterium avium and viral infection. The patient received anti-nontuberculous mycobacterium and antiviral treatment again, and fever subsided after treatment. For patients with nontuberculous mycobacterium pulmonary disease, when systemic bone destruction occurs while pulmonary lesions resolve, the possibility of other nontuberculous mycobacterium infections complicated by bone destruction should not be ignored.