Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report.
Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report.
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DOI：
10.1186/s12879-021-06436-6
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发表时间：
2021-08-04
影响因子：
3.7
通讯作者：
Mao MJ
中科院分区：
文献类型：
--
作者：
Pan L;Pan XH;Xu JK;Huang XQ;Qiu JK;Wang CH;Ji XB;Zhou Y;Mao MJ
播散性诺卡氏菌病的临床表现和实验室/影像学检查无特异性，易误诊。宏基因组下一代测序（mNGS）是一种直接鉴定临床标本中所有微生物的不依赖培养的快速方法。患者男，72岁，因反复咳嗽、咳痰、发热、腹泻1月，意识不清1周于2019年2月20日入院。头部增强磁共振成像显示双侧大脑半球、脑干和小脑半球多发性病变。尽管所有分枝杆菌检测均为阴性，但推定诊断为播散性结核。然而，患者并未从抗结核治疗中获益。重复MRI显示脑内多个异常信号和脑膜增厚进展。随后将脑脊液和支气管肺泡灌洗液标本送去进行PMSeq宏基因组学测序;结果表明为诺卡氏菌。farcinica为主要病原体。停止抗TB治疗，并为患者开具磺胺甲恶唑联合利奈唑胺和美罗培南治疗诺卡氏菌病。患者的神经功能逐渐改善，并被转至华山医院。他于2019年4月19日出院，但于2019年5月26日死于持续腹泻。疑似诺卡氏菌病的患者并不总是对常规治疗有反应;因此，mNGS可以促进诊断和及时的治疗决策。
Disseminated nocardiosis is liable to be misdiagnosed owing to the non-specific clinical manifestations and laboratory/imaging findings. Metagenomic next-generation sequencing (mNGS) is a culture-independent and rapid method for direct identification of all microorganisms in clinical specimens. A 72-year-old man was admitted to our hospital on February 20, 2019 with a history of recurrent cough, expectoration, fever, and diarrhea since 1 month, and unconsciousness since 1 week. Contrast-enhanced magnetic resonance imaging of head showed multiple lesions in the bilateral cerebral hemispheres, brainstem, and cerebellar hemispheres. The presumptive diagnosis was disseminated tuberculosis, although all tests for mycobacterium were negative. However, the patient did not benefit from antituberculosis treatment. Repeat MRI showed multiple abnormal signals in the brain and progression of meningeal thickening. Cerebrospinal fluid and bronchoalveolar lavage fluid specimens were subsequently sent for PMSeq metagenomics sequencing; the results indicated Nocardia. farcinica as the predominant pathogen. The anti-TB treatment was stopped and the patient was prescribed sulphamethoxazole in combination with linezolid and meropenem for nocardiosis. He showed gradual neurological improvement and was transferred to Huashan Hospital. He was discharged from the hospital on April 19, 2019, but died of persistent diarrhea on May 26, 2019. Patients with suspected nocardiosis do not always respond to conventional treatment; therefore, mNGS can facilitate diagnosis and timely treatment decision-making.
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