Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report
Abstract Background 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 clin...
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-021-06436-6 |
| _version_ | 1818908927035703296 |
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| author | Lei Pan Xiao-hong Pan Jie-kun Xu Xiao-qing Huang Jun-ke Qiu Cai-hong Wang Xiao-bo Ji Yang Zhou Min-jie Mao |
| author_facet | Lei Pan Xiao-hong Pan Jie-kun Xu Xiao-qing Huang Jun-ke Qiu Cai-hong Wang Xiao-bo Ji Yang Zhou Min-jie Mao |
| author_sort | Lei Pan |
| collection | DOAJ |
| description | Abstract Background 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. Case presentation 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. Conclusions Patients with suspected nocardiosis do not always respond to conventional treatment; therefore, mNGS can facilitate diagnosis and timely treatment decision-making. |
| first_indexed | 2024-12-19T22:18:47Z |
| format | Article |
| id | doaj.art-5384716ddbb34e7b8236ccd03ee1c51c |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-19T22:18:47Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-5384716ddbb34e7b8236ccd03ee1c51c2022-12-21T20:03:42ZengBMCBMC Infectious Diseases1471-23342021-08-012111810.1186/s12879-021-06436-6Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case reportLei Pan0Xiao-hong Pan1Jie-kun Xu2Xiao-qing Huang3Jun-ke Qiu4Cai-hong Wang5Xiao-bo Ji6Yang Zhou7Min-jie Mao8Department of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineBGI PathoGenesis Pharmaceutical Technology, BGI-ShenzhenDepartment of Tuberculosis Intensive Care Unit, Affiliated Hangzhou Chest Hospital, Zhejiang University School of MedicineAbstract Background 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. Case presentation 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. Conclusions Patients with suspected nocardiosis do not always respond to conventional treatment; therefore, mNGS can facilitate diagnosis and timely treatment decision-making.https://doi.org/10.1186/s12879-021-06436-6Nocardia farcinicaTuberculosisMetagenomicsMisdiagnosis |
| spellingShingle | Lei Pan Xiao-hong Pan Jie-kun Xu Xiao-qing Huang Jun-ke Qiu Cai-hong Wang Xiao-bo Ji Yang Zhou Min-jie Mao Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report BMC Infectious Diseases Nocardia farcinica Tuberculosis Metagenomics Misdiagnosis |
| title | Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report |
| title_full | Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report |
| title_fullStr | Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report |
| title_full_unstemmed | Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report |
| title_short | Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report |
| title_sort | misdiagnosed tuberculosis being corrected as nocardia farcinica infection by metagenomic sequencing a case report |
| topic | Nocardia farcinica Tuberculosis Metagenomics Misdiagnosis |
| url | https://doi.org/10.1186/s12879-021-06436-6 |
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