Lung cavities after covid: MAC or covid?

Now that is a difficult question, because there have been reports of cavities after Covid (here is just one: https://casereports.bmj.com/content/13/7/e237245) and certainly MAC can cause cavities.

Here are a couple questions that might help decide:
Do you have any pre-existing lung conditions such as asthma, chronic bronchitis, history of frequent pneumonia?
Are/were you a smoker or vaper of tobacco or other substances?

The next piece, whether to treat or watch and wait, is the most difficult. Traditional recommendations, in the case of cavitary MAC (cavities > 2mm?), before Covid, was to err on the side of caution & treat.

But...it is unknown yet whether the lungs, post-Covid, can mend themselves and fight off MAC in an otherwise healthy person.

I would say, at this time, you might never know. Have you decided whether to go ahead with treatment or watch and wait?
Sue

I have bronchiectasis discovered in a CT two years ago. Never smoked. Cavity is 1.5 cm. Leaning toward treatment but really torn on whether to add the aerikayce. This forum has been a wonderful resource the past week since my diagnosis as I try and decide what to do.

Arikayce (or Amikacin) is a pretty big gun. I personally would reserve it in case the other antibiotics do not work, it can always be added later. Is the doctor talking about 3X/week or daily meds? I found the side effects of daily meds too much to tolerate. Again, these are choices that can be changed as treatment progresses - if 3X/week doesn't shrink the cavity, the doc can increase to daily.

Is your doc a MAC and/or Bronchiectasis specialist?
Sue

Dr Johnson (pulmonologist) at Mayo Jax. Working with Dr Bosch who is an Infectious Disease specialist there

Hello thorne! I had both of those drs at Mayo.

How are you doing, @thorne? Any update?

Thank you for asking. I am still waiting for the results of my second culture. Will decide about medication at that point. Will keep you posted. BTW -- I am on this forum everyday and I really appreciate all the wisdom and support everyone shares, especially the moderators. Thank you for all of your time and effort!

How do you like Dr Johnson?

Trying to make a long story short. I had Covid in January 2021 tested positive a month later when going for colonoscopy. Had colonoscopy in March. After that I was feeling wiped out still and having allergy symptoms. Went to allergist. Negative for allergies. He thought he heard some wheezing and sent me for chest X-ray. He told me to come back in 6months for nebulizer treatment This is normal for asthma. I do not have asthma. So went to PCP and added protein for fatigue and blood work which was normal. I was referred to pulmonologist. Breathing tests and blood work for hereditary emphysema were all good. I may have intermittent asthma. She sent me for CT chest in July and low and behold I have MAC lung disease. This was confirmed this June with bronchoscopy. This all started with Covid-19!

Per NTM treatment guidelines and FDA recommendation, Arikayce is only recommended in the case of refractory disease. Refractory/stubborn NTM is defined as lack of sputum conversion after at least 6 months on standard treatment (Big 3). I just started on Arikayce after 10 months of standard treatment (with only one month negative). On the plus side, my cavity did shrink by almost 50% after 7 months of 3 x week Big 3 treatment.