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 …

中文翻译：

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播散性非结核分枝杆菌感染患者的成骨细胞耀斑现象

一名既往健康的 64 岁女性因前部胸痛 2 个月就诊。体格检查发现一个 3.5×6.0 cm 的压痛肿块从她的胸骨中部突出，左臂有结痂的带状疱疹病变。CT 显示胸骨肿块为 3.8×4.2×6.2 cm，伴有溶骨性破坏，左上叶舌部轻度支气管扩张，椎骨和肋骨多处溶骨性病变（图 1A-C）。骨扫描显示颅骨、胸骨、肋骨、椎骨和骨盆骨的示踪剂摄取增加（图 2A）。胸骨肿瘤活检的病理结果是坏死性肉芽肿和抗酸杆菌的存在（图 1D-E）。标本和痰中鸟分枝杆菌复合体培养阳性。该患者的 HIV 检测呈阴性，但高滴度中和抗干扰素-γ (IFN-γ) 自身抗体呈阳性，提示 IFN-γ 自身抗体相关的播散性非结核分枝杆菌 (NTM) 感染。图 1 胸部 CT 显示 3.8×4.2×6.2 cm 胸骨软组织肿块伴溶骨性破坏（A，箭头），舌部轻度支气管扩张……