Abstract：
BACKGROUND: Pulmonary tuberculosis (PTB) is an important infectious disease that threatens the health and life of human beings. In the diagnosis of PTB, imaging plays a dominant role, but due to the increasing drug resistance of Mycobacterium tuberculosis, atypical clinical manifestations, \"different images with the same disease\" or \"different diseases with the same image\" in chest imaging, and the low positivity rate of routine sputum bacteriology, which leads to a high rate of misdiagnosis of PTB. We report a case of pulmonary tuberculosis that was misdiagnosed on imaging. We report a case of pulmonary tuberculosis that resembled sarcoidosis on imaging and was negative for antacid staining on sputum smear and alveolar lavage fluid, and was later diagnosed by microbial next-generation sequencing (NGS). The case was initially misdiagnosed as sarcoidosis.
METHODS: Alveolar lavage fluid NGS, chest CT, bronchoscopy.
RESULTS: Chest CT showed multiple inflammatory lesions in both lungs, multiple nodular foci in both lungs, and multiple enlarged lymph nodes in the mediastinum and hilar region on both sides. Fiberoptic bronchoscopy was performed in the basal segment of the left lower lobe of the lungs to carry out bronchoalveolar lavage, and the lavage fluid was sent to the NGS test and returned the following results: Mycobacterium tuberculosis complex group detected in the number of sequences of 293. Based on the results of the NGS test, the diagnosis of pulmonary tuberculosis could be confirmed.
CONCLUSIONS: The diagnosis of pulmonary tuberculosis cannot be easily excluded in patients with \"different images with the same disease\" or \"different diseases with the same image\" on chest imaging without the support of sputum positivity. The goal was to improve the alertness of medical personnel to the misdiagnosis of tuberculosis and the application of NGS technology.
METHODS: Alveolar lavage fluid NGS, chest CT, bronchoscopy.
RESULTS: Chest CT showed multiple inflammatory lesions in both lungs, multiple nodular foci in both lungs, and multiple enlarged lymph nodes in the mediastinum and hilar region on both sides. Fiberoptic bronchoscopy was performed in the basal segment of the left lower lobe of the lungs to carry out bronchoalveolar lavage, and the lavage fluid was sent to the NGS test and returned the following results: Mycobacterium tuberculosis complex group detected in the number of sequences of 293. Based on the results of the NGS test, the diagnosis of pulmonary tuberculosis could be confirmed.
CONCLUSIONS: The diagnosis of pulmonary tuberculosis cannot be easily excluded in patients with \"different images with the same disease\" or \"different diseases with the same image\" on chest imaging without the support of sputum positivity. The goal was to improve the alertness of medical personnel to the misdiagnosis of tuberculosis and the application of NGS technology.
摘要：
背景：肺结核（PTB）是威胁人类健康和生命的重要传染病。在PTB的诊断中，成像起着主导作用，但是由于结核分枝杆菌的耐药性增加，不典型的临床表现，胸部成像中的“具有相同疾病的不同图像”或“具有相同图像的不同疾病”，常规痰细菌学阳性率低，导致PTB的误诊率较高。我们报告了一例影像学误诊的肺结核。我们报告了一例肺结核，影像学上类似结节病，痰涂片和肺泡灌洗液的抗酸染色阴性，后来通过微生物下一代测序（NGS）诊断。该病例最初被误诊为结节病。
方法：肺泡灌洗液NGS，胸部CT,支气管镜检查。
结果：胸部CT显示双肺多发炎性病变，双肺有多个结节灶,两侧纵隔及肺门区多发肿大淋巴结。在肺左下叶基底段进行纤维支气管镜检查,进行支气管肺泡灌洗,将灌洗液送至NGS检测并返回以下结果：结核分枝杆菌复合体组检测到的序列数为293。根据NGS测试的结果，可以确诊肺结核。
结论：在没有痰阳性支持的情况下，胸部影像学上“同一疾病的不同影像”或“同一疾病的不同影像”患者不能轻易排除肺结核的诊断。目的是提高医务人员对结核病的误诊和NGS技术应用的警觉性。
方法：肺泡灌洗液NGS，胸部CT,支气管镜检查。
结果：胸部CT显示双肺多发炎性病变，双肺有多个结节灶,两侧纵隔及肺门区多发肿大淋巴结。在肺左下叶基底段进行纤维支气管镜检查,进行支气管肺泡灌洗,将灌洗液送至NGS检测并返回以下结果：结核分枝杆菌复合体组检测到的序列数为293。根据NGS测试的结果，可以确诊肺结核。
结论：在没有痰阳性支持的情况下，胸部影像学上“同一疾病的不同影像”或“同一疾病的不同影像”患者不能轻易排除肺结核的诊断。目的是提高医务人员对结核病的误诊和NGS技术应用的警觉性。
