Case 1 was a 49-year-old woman who visited with a dry cough. She had an\nunderlying disease of lung adenocarcinoma and received cancer immunotherapy\nbecause of an ALK-positive response and several cancer chemotherapies.\nThe clinical effect was a complete response. Chest CT was performed because\nof continuous dry cough, and a new tumor shadow was recognized in the\nlingula portion of the left upper lobe. We performed CT-guided lung biopsy\nand could aspirate pus-fluid. The culture test for acid-fast bacilli was positive\nand the causative microorganism was identified as Mycobacterium avium by\nthe DDH method. The final diagnosis was pulmonary abscess due to M.\navium. Treatment using combined chemotherapy including CAM was performed\nand a good clinical response was obtained. Case 2 was a 67-year-old\nman who had a past history of surgical resection of lung adenocarcinoma\neight and two years ago and received several cancer chemotherapies and radiation\ntherapy. Because a new nodular shadow appeared in the right middle\nlobe one year ago and showed strong positivity on PET/CT, surgical resection\nwas performed with the suspected recurrence of lung cancer. Subsequently,\nthe histological diagnosis was epithelioid granuloma and a culture test of acid-\nfast bacilli was positive, with the identification of Mycobacterium intracellulare\nby the DDH method. Combined chemotherapy was not performed because\nthe lesion was completely resected. Afterwards, a new nodular shadow\nappeared in the left lower lobe again and bronchoscopy was performed. Because\nM. intracellulare was isolated from the local specimen, we diagnosed\nthe patient with recurrence of pulmonary MAC disease and combined chemotherapy\nincluding CAM was performed for one year. Finally, the nodular\nlesion disappeared. It is difficult to differentiate pulmonary MAC disease\nfrom lung cancer. Therefore, careful follow-up of patients with lung cancer\nwhile keeping in mind the possible complication of pulmonary MAC disease\nis necessary.
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