A Study of Clinical Misdiagnosis of Non-tuberculous Mycobacteria Pulmonary Disease

LIN Ai-qing; YANG Xiao-guang; LIU Guo-li; LI Shu-yan; LIU Shi-zheng

doi:10.3969/j.issn.1002-3429.2016.09.004

Abstract：Objective To analyze the clinical characteristics of nontuberculous mycobacteria pulmonary disease and its diagnostic and treatment methods. Methods One misdiagnosed case of non-tuberculous mycobacteria pulmonary disease was retrospectively analyzed, and relevant literatures were reviewed. Results The patient was admitted for 4 d of physical lung shadow. The patient had been diagnosed as having lung space-occupying lesions ( with /without lung cancer) by pulmo-nary CT in another hospital. She was admitted to our hospital to confirm diagnosis. Chest enhanced CT also showed lung space-occupying lesions ( with /without lung cancer) , and lung puncture was performed. Lung biopsy results were interstitial pneumonia, and the patient underwent Levofloxacin and Cephalosporin treatment. After 10 d of treatment, the third lung CT showed an enlargement of lesion. Meanwhile, sputum culture was positive for tuberculosis. Mycobacterium species identifica-tion of gene chip detection, suggested that it was NTM. The patient was diagnosed as having NTM lung disease, and under-went Rifabutin, Ethambutol and Azithromycin treatment. After 3 weeks of treatment, the forth lung CT showed that lung le-sions were significantly aborted, and then the patient was discharged from hospital. She was stable condition during follow-up for three months. Conclusion When normal clinical anti-infection therapy is inefficient and the imaging findings show that many lesion forms exist during the same period, including small patchy shadows, cavities, consolidation and bronchiectasis, the nontuberculous mycobacteria pulmonary disease is suggested, and sputum culture and strain identification should be under-taken as soon as possible in order to reduce missed diagnosis and misdiagnosis rates.