Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report
| Autor: | Xiaohong Pan, Lei Pan, Minjie Mao, Xiao-bo Ji, Xiao-qing Huang, Caihong Wang, Junke Qiu, Yang Zhou, Jiekun Xu |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Tuberculosis Nocardia farcinica Misdiagnosis Nocardia Infections Case Report Infectious and parasitic diseases RC109-216 Meropenem Nocardia 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Diagnostic Errors Aged biology medicine.diagnostic_test business.industry Nocardiosis biology.organism_classification medicine.disease Diarrhea Infectious Diseases Bronchoalveolar lavage chemistry Linezolid Metagenomics medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-8 (2021) BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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