Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Disseminated Tuberculosis of an Immunocompetent Patient

Abstract

Disseminated tuberculosis (TB) is a rare disease and mainly occurs in immunodeficient patients. It is marked by hematogenous or lymphatic dissemination of Mycobacterium tuberculosis, causing tuberculous infection involving any organ system. Here, we report a case of disseminated TB involving lung, liver, spine, mediastinum, and prostate in an immunocompetent man. The present patient found a hepatic mass without any symptom during health examination. In the next 2 years, further examinations revealed multiple lesions in the lung, mediastinum, spine, and prostate. Imaging examinations, such as contrast-enhanced abdominal CT, F-18 FDG-PET/CT, and radionuclide bone scan, suggested the diagnosis of malignancy or metastatic tumor. Furthermore, histopathological results of the biopsies of the hepatic mass, mediastinal mass, and prostatic mass demonstrated granulomatous inflammation. Therefore, metagenomic next-generation sequencing (mNGS) was utilized to confirm the diagnosis. Mycobacterium tuberculosis complex was simultaneously detected in the spinal surgical resection specimens and bronchoalveolar lavage fluid (BALF), indicating the diagnosis of disseminated TB. mNGS is an emerging molecular diagnostic technology, and its application in disseminated TB has been rarely reported. We highlight that disseminated TB should be considered even in an immunocompetent patient, and mNGS can be performed when the diagnosis is difficult.

Evaluation of the metagenomic next-generation sequencing performance in pathogenic detection in patients with spinal infection

“…In addition, mNGS has been proven to be more sensitive than broad-range PCR for detecting prosthetic joint infection in joint fluid and be capable of identifying more pathogens in polymicrobial and fungal infections ( Wang et al., 2020 ). In spinal-related infection, disseminated tuberculosis has been successfully diagnosed using mNGS from the resected sample from spinal surgery ( Ye et al., 2021 ).…”

Clinical application of metagenomic next-generation sequencing in tuberculosis diagnosis

“…Early timely and correct diagnosis of TB is a necessary condition to cure TB, especially latent TB infection. Although case studies demonstrate the great potential of mNGS in diagnose disseminated TB and extrapulmonary TB, there are few studies of overall TB ( Zhang et al., 2019 ; Ye et al., 2021 ). This cohort study applied mNGS to clinical samples to assess its diagnostic efficacy for TB and extrapulmonary TB.…”

Clinical Evaluation of Metagenomic Next-Generation Sequencing for the detection of pathogens in BALF in severe community acquired pneumonia

“…Therefore, when clinically considering the presence of MTB infection, traditional methods rather than mNGS should be considered rst. MTB, a type of intracellular bacteria, releases less nucleic acid into the extracellular environment, and insu cient wall fracture can also affect the extraction of DNA; therefore, fewer sequences can be detected (43,44). mNGS combined with MTB-Xpert can be used to improve diagnostic rates (11,43).…”