The most common presentations of nontuberculous mycobacterial infections in 
kidney transplant recipients (KTR) are cutaneous and disseminated diseases. 
Pleuropulmonary infection not associated with disseminated disease is rare. Its 
diagnosis can be difficult, requiring a combination of clinical, radiological, 
and bacteriological criteria. We report on a Mycobacterium avium complex 
pulmonary infection in a KTR with underlying chronic obstructive pulmonary 
disease. Chest computed tomography showed an excavated lesion of the right upper 
lobe, similar to a typical lesion of pulmonary tuberculosis. Evolution was 
favorable with multiple-drug therapy including rifampicin, ethambutol, and 
clarithromycin, along with a slight reduction in immunosuppression. We review 
the literature and discuss the epidemiology, diagnosis, management, and 
follow-up of this uncommon post-transplant complication.