Complete resolution of non-tuberculous mycobacterial pulmonary nodule following cryobiopsy: he first case report

Abstract Non-tuberculous mycobacterial (NTM) lung disease encompasses a diverse group of pulmonary conditions, present significant diagnostic challenges, especially in radiological interpretation. The disease can mimic lung cancer, tuberculosis, and other bronchopulmonary disorders, complicating accurate diagnosis. Case Presentation: A 46-year-old healthy woman was incidentally found to have a 1.3-cm pulmonary nodule in the left anterior basal segment during a routine health examination, with no symptoms or significant medical history. Initial CT imaging raised suspicions of T1a lung cancer. Subsequent endobronchial ultrasound transbronchial lung biopsy (EBUS-TBLB) and transbronchial lung cryobiopsy (TBLC) revealed granulomatous inflammation. Tests for tuberculosis and NTM were negative. Following the biopsies, chest X-rays showed an enlarged shadow at the lesion, suggesting necrosis after cryobiopsy. The patient was treated with moxifloxacin, leading to symptom improvement. A final diagnosis of NTM infection, specifically Mycobacterium avium, was confirmed from bronchoalveolar lavage (BAL) fluid. At four months post-biopsy, a chest CT scan showed complete resolution of the nodule. Conclusion: NTM nodules may undergo necrosis and resolution due to the ablation effect of cryobiopsy, suggesting cryoablation as a potential option for inoperable localized NTM disease.