Article Text

Download PDFPDF
Osteoblastic flare phenomenon in a patient treated for disseminated non-tuberculous mycobacterial infection
  1. Ruei-Lin Sun1,2,
  2. Sheng-Wei Pan1,2,3,
  3. Jia-Yih Feng1,2,
  4. Chun-Yu Liu2,4,
  5. Yuh-Min Chen1,2
  1. 1 Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
  3. 3 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
  4. 4 Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  1. Correspondence to Dr Sheng-Wei Pan, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; sanweipan{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

A previously healthy 64-year-old woman presented with a 2-month history of anterior chest pain. Physical examination disclosed a 3.5×6.0 cm tender mass protruding from her mid-sternum and crusted herpes zoster lesions on her left arm. CT revealed a 3.8×4.2×6.2 cm sternal mass with osteolytic destruction, mild bronchiectasis in the lingula of the left upper lobe and multiple osteolytic lesions over vertebrae and ribs (figure 1A–C). Bone scintigraphy revealed increased tracer uptake at skull, sternum, ribs, vertebrae and pelvic bones (figure 2A). Pathological findings of the sternal tumour biopsy were necrotising granuloma and the presence of acid-fast bacilli (figure 1D–E). The specimen and sputum were culture-positive for Mycobacterium avium complex. The patient was tested negative for HIV but positive for high-titre neutralising anti-interferon-γ (IFN-γ) autoantibodies, suggesting IFN-γ autoantibody-related disseminated non-tuberculous mycobacterial (NTM) infection.

Figure 1

Chest CT showed a 3.8×4.2×6.2 cm sternal soft-tissue mass with osteolytic destruction (A, arrow), mild bronchiectasis in the lingula …

View Full Text


  • Contributors S-WP, J-YF and C-YL were involved in the care of the patient. All authors contributed to the conception, interpretation, drafting and revision of the manuscript. R-LS and S-WP approved the final version of the manuscript.

  • Funding This report was supported by Taipei Veterans General Hospital [V110C-042] and the Ministry of Science and Technology, Taiwan [MOST 110-2314-B-075 -077].

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.