Endobronchial Mycobacterium Avium-Intracellulare Infection in Lung Transplant Recipients

• Endobronchial Mycobacterium avium-intracellulare (MAI) infection was detected in a lung transplant recipient despite the absence of symptoms and normal pulmonary function. • Multiple polypoid lesions were identified during routine bronchoscopy, emphasizing the need for regular post-transplant monitoring to catch atypical infections early. • The patient's MAI lesions were managed with lesion removal during bronchoscopy, without immediate antimycobacterial therapy, due to stable lung function. • The case raises the possibility of a connection between coal workers’ pneumoconiosis and susceptibility to MAI infections post-transplant, an area needing further research. Endobronchial Mycobacterium avium-intracellulare (MAI) infection has been described in immunocompromised patients but is rare among transplant recipients. We present a case of a 48-year-old male with a history of coal miners’ pneumoconiosis who underwent bilateral lung transplantation. Ten months post-transplant, despite normal spirometry and absence of respiratory symptoms, routine surveillance bronchoscopy revealed multiple endobronchial polypoid lesions. Biopsy demonstrated non-necrotizing granulomatous inflammation, with cultures confirming MAI infection. This case underscores the importance of maintaining a high index of suspicion for atypical infections like MAI in lung transplant recipients, even in the absence of overt clinical symptoms. This case's unique presentation adds to our understanding of potential post-transplant complications and may help clinicians recognize similar presentations in the future.