Lipid pneumonia with atypical mycobacterial colonization. Association with allergic bronchopulmonary aspergillosis

Exogenous lipid pneumonia following bronchography occurred in a woman with allergic bronchopulmonary aspergillosis (ABPA) whose bronchi had been colonized with Mycobacterium chelonei chelonei for the previous year. The lung biopsy specimen disclosed organisms within lipid vacuoles in the areas of lipid pneumonia, while caseating granulomas, the usual tissue reaction to pathogenic mycobacteria, were absent. These pathologic findings suggested that the infection with M chelonei was noninvasive, and we were able to continue the corticosteroid therapy that was necessary for control of the underlying ABPA.