From the Guidelines
Treatment for neutrophil-predominant leukocytosis with monocytes and tree-in-bud nodularity on CT scan of the chest should be guided by the underlying cause, which is often infectious, and MAC infection is a possible cause, especially in patients with characteristic radiographic features, such as tree-in-bud nodularity, and clinical presentations, including chronic cough, fever, and weight loss 1.
Recommendation
Start with broad-spectrum antibiotics such as Ceftriaxone 2 grams IV every 12 hours or Cefepime 2 grams IV every 8 hours, and consider adding a macrolide like Azithromycin 500 mg IV or orally once daily for at least 7-10 days, depending on the clinical response and microbiological results.
Additionally, consider treating for possible mycobacterial infection with a regimen that includes Rifampin 600 mg orally once daily, Isoniazid 300 mg orally once daily, Ethambutol 1.2 grams orally once daily, and Pyrazinamide 1.5 grams orally once daily for at least 6 months, if mycobacterial infection is suspected, as recommended by expert consensus 1.
- Corticosteroids like Prednisone 40-60 mg orally once daily may be considered for a short duration (less than 2 weeks) if there's significant inflammation, but this should be done with caution and under close monitoring due to the potential for worsening infection.
- It's crucial to monitor the patient's clinical response, adjust the treatment based on microbiological results, and consider consultation with infectious disease specialists for personalized management, as the treatment of MAC-associated lung disease can be complex and requires careful consideration of the patient's individual needs 1.
- The choice of treatment should be guided by the severity of symptoms, the presence of underlying conditions, and the results of microbiological tests, and should be adjusted accordingly to ensure the best possible outcome for the patient.
From the Research
Treatment for Neutrophil-Predominant Leukocytosis
- The treatment for neutrophil-predominant leukocytosis with monocytes and tree-in-bud nodularity on CT scan of the chest is not directly addressed in the provided studies.
- However, the studies suggest that tree-in-bud nodularity is often associated with infectious etiologies, such as pneumonia 2.
- In cases of pulmonary tuberculosis, treatment response can be monitored using leukocyte ratios, including Neutrophil Lymphocyte Ratio (NLR), Monocyte Lymphocyte Ratio (MLR), and Neutrophil Monocyte Ratio (NMR) 3.
- For chronic myelomonocytic leukemia (CMML), which is a clonal disorder of hematopoietic cells, the standard treatment principles have not yet been clearly defined, but hypomethylating agents are mainly considered the frontline therapy in most cases 4.
Diagnostic Approaches
- The diagnosis of CMML can be improved using structural parameters of Sysmex XNTM analyzers in routine laboratory practice, including neutrophil/monocyte ratio, structural neutrophil dispersion, and monocyte absolute value 5.
- Tree-in-bud pattern on chest CT can be used to identify patients with endobronchiolar inflammation, which is often caused by infectious etiologies 2.
- Neutrophil heterogeneity, functional versatility, and signaling can provide insight into the mechanisms that distinguish protective and dysregulated, excessive inflammation 6.