Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis:a case report and literature review

Background:Tuberculosis(TB)is a great mimicker and diagnostic chameleon,and prone to be diagnosed as malignancy.Even though many reports have described the differences between pulmonary TB and lung cancer,the atypical systemic hematogenous disseminated TB(HDTB)is very rare and more confusing in clinical practice.Case presentation:A 73-year-old man,HIV-negative,was hospitalized to the local county hospital because of chest pain,low-grade fever,asthenia,anorexia and weight loss for the pasting two months.The CT findings of the two lungs showed multiple round or round-like nodules of different sizes,with clear boundaries and partial fusion.The level of serum CA19–9 was significantly higher than normal,and progressively increased.There were multiple enlarged lymph nodes in the neck,mediastinum,abdominal cavity and pelvic cavity.The symptoms were diagnosed as hematogenous spread of gastrointestinal tumor in the local county hospital.However,when transferred to our provincial hospital,through comprehensive dynamic analysis,this patient was diagnosed as atypical systemic HDTB,no cancer at all.Through routine anti-TB therapy for one year,the patient was recovered very well at the follow-up of half year after withdrawal.Conclusions:In the past,most TB misdiagnosis cases involved in single organ and were finally confirmed through invasive examination.This case enriched clinical experiences in the diagnosis of atypical HDTB.We encouraged clinicians to establish a dynamic thinking for diagnosis and treatment and emphasized the value of biopsy and 18FFDG-PET in distinguishing TB and cancer.

Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

Background： Nontuberculous Mycobacterium （NTM） bloodstream infection （BSI） is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI. Methods： We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series ofNTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ~ standard deviation （SD）. Data of nonnormal distribution were expressed by median and interquartile range （IQR）. Results： Among the ten patients with NTM BSI, the median age was 51 years （IQR 29-57 years） and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus （HIV） infection （one patient）, rheumatic diseases （two patients）, breast cancer （one patient）, myelodysplastic syndrome （two patients）, and aplastic anemia （two patients）. Other organ（s） involved were lung （two patients）, endocardium （two patients）, brain, spinal cord, and soft tissue （one each patient）. The median lymphocyte was 0.66 x 109/L （IQR 0.24-1 .93 × 10^9/L）. The median cluster of differentiation 4 （CD4） cell count was 179/ mm^3 （IQR 82-19/mm^3）. Five patients died （three with hematological diseases, one with breast cancer, and one with rheumatic disease）, three recovered, and two were lost to follow-up. Conclusions： We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.