Pneumatosis Cystoides Intestinalis Complicated during Chemotherapy for Pulmonary Nontuberculous Mycobacterial Disease

Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of gas in the intestinal wall. Aim: We report two rare cases of PCI that are complicated during the chemotherapy for pulmonary nontuberculous mycobacterial (NTM) disease. Case Presentation: In this report, we described two cases (a 72-year-old woman and a 60-year-old woman) of PCI that appeared during the combined chemotherapy consisting of rifampicin, ethambutol and clarithromycin. Because there were few clinical symptoms and increased inflammatory responses, the diagnosis of PCI was delayed. However, there were fortunately no severe complications in both cases. Conclusion: Respiratory physicians should be aware of the potential development of PCI in patients during the chemotherapy for pulmonary NTM disease. It is important to detect PCI in the early stage through radiological examinations to avoid severe complications.

Epidemiology and Clinical Features of Mycobacterium avium Complex Pulmonary Disease in a Brazilian Amazon Cohort

The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.

Molecular Epidemiology of Nontuberculous Mycobacteria in a German CF Center and Clinical Course of NTM Positive Patients

Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multilocus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not characterized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. abscessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.

Pulmonary sequestration infected with nontuberculous mycobacteria:a report of two cases and literature review

We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria(NTM): Mycobacterium avium and Mycobacterium abscessus.Chest computed tomography showed pneumonic consolidation in the right lower lobe,which received a systemic blood supply from the descending aorta in both patients.Video-assisted thoracoscopic surgeries were successfully performed and pathologica]examinations revealed multiple caseating granulomas.A review of the literature revealed only seven previous case reports of pulmonary sequestration infected with NTM,and no case with Mycobacterium abscessus has been reported.

天津地区106例NTM肺病患者的菌种分布及临床特征分析

目的分析天津地区非结核分枝杆菌(NTM)肺病患者的菌种分布及临床特征,为天津地区NTM肺病临床诊治提供参考。方法选取NTM肺病患者106例,分析NTM菌种分布情况、不同NTM菌种感染患者合并症和临床表现分布、胸部影像学表现;比较感染胞内分枝杆菌、龟脓肿分枝杆菌和堪萨斯分枝杆菌患者白细胞、血红蛋白、血白蛋白水平。结果106例NTM肺病患者,分布在前3位的菌种是胞内分枝杆菌(39.62%,42/106)、堪萨斯分枝杆菌(23.58%,25/106)和龟脓肿分枝杆菌(23.58%,25/106)。患者主要的合并症有肺结核、支气管扩张、慢性阻塞性肺疾病和糖尿病。就诊时临床表现以咳嗽咳痰最为常见(64.15%,68/106),其次为发热(35.85%,38/106),气短喘息(16.98%,18/106)和咯血(16.04%,17/106)等。100例患者的影像学特征表现以渗出、空洞及支气管扩张为主。胞内分枝杆菌感染患者胸腔积液比例高于龟脓肿分枝杆菌和堪萨斯分枝杆菌感染患者(P<0.05);堪萨斯分枝杆菌感染患者支气管扩张比例低于胞内分枝杆菌和龟脓肿分枝杆菌感染患者(P<0.01)。胞内分枝杆菌感染患者血红蛋白水平低于龟脓肿分枝杆菌和堪萨斯分枝杆菌感染患者(P<0.05),白蛋白水平低于龟脓肿分枝杆菌感染患者(P<0.05)。结论天津地区NTM肺病患者流行菌种以胞内、堪萨斯、龟脓肿分枝杆菌为主,临床表现多为咳嗽咳痰、发热等,影像学表现以渗出、空洞及支气管扩张为主。

Clinical Analysis of Pulmonary Nontuberculous Mycobacterial Disease Complicated by Lung Cancer during the Follow-Up Periods

Introduction: The objective of this study was the estimation of the clinical characteristics of patients with pulmonary nontuberculous mycobacterial (NTM) disease complicated by lung cancer during the follow-up periods. Methods: We analyzed the clinical findings of four patients (2.0%) complicated by lung cancer during the follow-up periods of over six months at least after the definite diagnosis of pulmonary NTM disease of 202 patients with pulmonary NTM disease experienced in our hospital in the last decade. Results: There were four patients with pulmonary NTM disease complicated by lung cancer and all of them were caused by Mycobacterium avium complex (MAC). They were all elderly male patients and had underlying diseases. Three patients were diagnosed with primary lung cancer and one diagnosed with metastatic lung cancer from colon cancer within 3 years after the diagnosis of pulmonary NTM disease. The treatments for lung cancer were surgical resection for all patients with localized lesions. One patient died due to the worsening of underlying disease and the remaining three survived except for the recurrence of one patient. Conclusion: Although the complication rate of pulmonary NTM disease and lung cancer was a lower percentage (2.0%) than in previous reports, the careful follow-up for patients with pulmonary NTM disease without forgetting the possible complication of lung cancer is necessary.

切取活检法在皮肤非结核分枝杆菌检测中的应用

目的:明确规范应用切取活检法对提高皮肤NTM病原体检出率的意义。方法:对2021-2024年采用切取活检法进行感染皮肤组织取材临床诊断为非结核分枝杆菌感染的9例患者资料进行回顾性分析,分析内容包括皮肤组织抗酸涂片、组织病理抗酸染色及细菌培养。结果:9例患者中,皮损脓液或皮下组织直接抗酸涂片阳性8例,组织培养6例培养出分枝杆菌,培养阳性率75%,病理抗酸涂片阳性1例。结论:切取活检法可用于皮肤非结核分枝杆菌感染的病原学取材,且取脓液和皮下坏死组织培养阳性检出率更高。

反复误诊的偶发分枝杆菌感染一例

医源性偶发分枝杆菌感染多与手术伤口、器官移植、透析和注射等有关。本文报道注射后发生的偶发分枝杆菌感染一例,曾多次被误诊为“软组织感染、坏疽性脓皮病”等,最终通过病理、培养和PCR测序确诊,并对分离菌株体外药敏试验。患者经亚胺培南西司他丁钠、阿米卡星、环丙沙星等药物治疗后痊愈,随访5年,患儿无不良反应发生。

基因芯片法鉴定NTM及其不同菌种药敏结果分析

目的探讨非结核分枝杆菌(nontuberculous mycobacterium,NTM)在区域内分布及常见菌种药敏结果,为临床治疗NTM病提供用药参考。方法采用基因芯片法进行NTM菌种鉴定,对不同类型菌种进行归类,并采用微量稀释法进行NTM药物敏感试验,依据CLSI标准判断结果,计算药物对细菌的MIC50和MIC90值,分析药敏结果。结果成功鉴定出8种NTM菌种,包括鸟分枝杆菌、胞内分枝杆菌、龟分枝杆菌或脓肿分枝杆菌、偶然分枝杆菌、堪萨斯分枝杆菌、戈登分枝杆菌、蟾蜍分枝杆菌和土分枝杆菌。其中以鸟分枝杆菌、胞内分枝杆菌和龟分枝杆菌或脓肿分枝杆菌为主,分别占25.3%、29.1%和30.4%。鸟分枝杆菌对利奈唑胺、阿米卡星药物敏感性均为100%,对利福平、克拉霉素、莫西沙星和利福布丁等药物敏感性均在80%以上;胞内分枝杆菌对莫西沙星、利奈唑胺、阿米卡星等药物敏感性达80%以上,其次对利福平、利福布丁和克拉霉素敏感性达到70%以上;龟分枝杆菌或脓肿分枝杆菌对阿米卡星敏感性达93.7%,对克拉霉素和利奈唑胺敏感性均为62.5%。结论明确了NTM在本地区的菌株分布和常见NTM菌种的药敏结果,为临床治疗提供理论依据。

结核/非结核分枝杆菌核酸检测对结核性脑膜炎的诊断价值

目的探讨脑脊液中结核/非结核分枝杆菌(mycobacterium tuberculosis/nontuberculous mycobacteria,MTB/NTM)核酸检测诊断结核性脑膜炎(tuberculous meningitis,TBM)的临床价值。方法收集120例TBM患者的临床资料,采用随机数字表法将患者分为TBM A组(n=67,进行脑脊液常规、生化、罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测)和TBM B组(n=53,进行脑脊液常规、生化、罗氏培养、涂片查抗酸菌、GeneXpert MTB/RIF检测),另收集其他中枢神经系统感染患者脑脊液18例为对照组(C组,进行脑脊液常规、生化、罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测、GeneXpert MTB/RIF检测)。结果TBM A组脑脊液罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测阳性率分别为13.43%(9/67)、10.45%(7/67)、46.27%(31/67);TBM B组脑脊液罗氏培养、涂片查抗酸菌、GeneXpert MTB/RIF检测阳性率分别为15.09%(8/53)、11.32%(6/53)、47.17%(25/53),GeneXpert MTB/RIF检测阳性病例中利福平耐药基因检测阳性2例。C组脑脊液罗氏培养、涂片查抗酸菌、MTB/NTM核酸检测和GeneXpert MTB/RIF检测均为阴性。结论MTB/NTM核酸检测与GeneXpert MTB/RIF检测均可辅助早期诊断TBM,相较于后者更经济,并能鉴别非结核分枝杆菌(nontuberculous mycobacteria,NTM)感染,及时减少NTM病误诊、误治,值得临床推广。

非结核分枝杆菌肺病患者的临床特征及治疗转归相关因素分析

目的分析台州市非结核分枝杆菌肺病(nontuberculous mycobacterial pulmonary disease,NTM-PD)患者的临床特征及治疗转归相关因素,为NTM-PD的管理和诊治提供参考依据。方法回顾性分析于2016年1月至2021年12月在浙江省台州医院确诊的167例NTM-PD患者的临床特征。比较分析83例鸟分枝杆菌复合群肺病(Mycobacterium avium complex pulmonary disease,MAC-PD)患者治愈组和失败组在临床特征上的差异。结果167例NTM-PD患者中检测到的主要为MAC-PD,占94.6%,其中88例得到治疗,治愈率47.7%。与治愈组比较,失败组患者在体质量指数(body mass index,BMI)≤18.5kg/m^(2)、抗酸涂片阳性、合并结核病史、有纤维空洞和未规范治疗等方面差异有统计学意义(P<0.05)。结论台州市NTM-PD患者以MAC-PD最为常见,BMI≤18.5kg/m^(2)、抗酸涂片阳性、合并结核病史、有纤维空洞和未规范治疗的MAC-PD患者的治疗难度更大。

副戈登分枝杆菌性角膜炎1例

43岁女性,主诉左眼反复红痛4年余,伴视物模糊2年余。患者起病时,以左眼反复晨起时红痛流泪为特点,结合既往有左眼角膜划伤外伤诱因以及近视激光矫正手术史,考虑左眼复发性角膜上皮糜烂。此后患者出现左眼中央灰白色病灶,边界不清,角膜基质雾状水肿,但病原学检测均为阴性,经验性的抗细菌及抗真菌治疗后好转。之后患者感染新型冠状病毒后症状反复,又呈现出病毒性角膜炎的特征,诊断性治疗好转后又出现了角膜表面坏死灶和卫星灶的表现。后收入院行左眼角膜清创活检术,术中取坏死组织送宏基因组检测,最终明确副戈登分枝杆菌感染,术后予以阿米卡星及加替沙星局部抗感染治疗后病情得到控制。讨论体会:副戈登分枝杆菌性角膜炎的临床表现有一定伪装性,对于有近视激光手术史的不典型角膜炎表现时需警惕非结核分枝杆菌感染。常规病原检查难以明确病因时可借助宏基因组检测来及早诊断。对于非结核分枝杆菌性角膜炎,敏感抗生素局部治疗应足量、足疗程、防毒副作用,必要时采用角膜瓣切除开放创面。

新型大环内酯类治疗小儿NTM感染疗效观察

目的探讨克拉霉素(Clarithromycin)和阿奇霉素(Azithromycin)治疗小儿非结核分支杆菌感染的疗效及毒副作用。方法回顾性分析22例儿科龟分支杆菌切口感染患儿的克拉霉素和阿奇霉素的应用方法、疗程及副作用。结果22例中21例应用克拉霉素,20例转用阿奇霉素。治愈率为100%。克拉霉素组副作用大于阿奇霉素组(P<0.01)。随访5年,无复发病例。结论应用克拉霉素和阿奇霉素治疗龟分支杆菌感染,治愈率高达100%,阿奇霉素较克拉霉素更安全。

Comparing the Genotype and Drug Susceptibilities between Mycobacterium avium and Mycobacterium intracellulare in China

Objective Mycobacterium avium （M. avium） and Mycobacterium intracellulare （M. intracellulare） are the major causative agents of nontuberculous mycobacteria （NTM）-related pulmonary infections. However, little is known about the differences in drug susceptibility profiles between these two species. Methods A total of 393 NTM isolates were collected from Shanghai Pulmonary Disease Hospital. Sequencing of partial genes was performed to identify the strains at species level. The minimum inhibitory concentration （MIC） was used to evaluate the drug susceptibility against 20 antimicrobial agents. Variable number of tandem repeat （VNTR） typing was conducted to genotype these two species. Results A total of 173 （44.0%） M. avium complex （MAC） isolates were identified, including 41 （10.4%） M. avium isolates and 132 （33.6%） M. intracellulare isolates. Clarithromycin and amikacin were the two most effective agents against MAC isolates. The Hunter-Gaston Discriminatory Index （HGDI） values for VNTR typing of M. avium and M. intracellulare isolates were 0.993 and 0.995, respectively. Levofloxacin resistance was more common among the unclustered strains than among the clustered strains of M. intracellulare. Conclusion M. intrecellulare was the most common NTM species in China. Clarithromycin and amikacin had high antimicrobial activities against MAC. VNTR typing of MAC isolates revealed a high discriminatory power. Levofloxacin resistance was associated with unclustered strains of M. intracellulare.

Prevalence and Antimicrobial Susceptibility of Mycobacterium abscessus in a General Hospital, China

Objective To gain greater insight into the prevalence drug resistant profiles of M. abscessus from a general hospital in Beijing, China. Methods Partial gene sequencing of 16 S, hsp65, and rpo B were used to distinguish the species of NTM isolates. All strains identified as M. abscessus were further enrolled in the drug susceptibility testing by using broth microdilution method. Results We found that M. avium complex was the most frequent NTM organism, accounting for 54.1%（33/61） of all isolates. Behind MAC, the second most common organisms were M. abscessus（22 out of 61, 36.1%）. Average rates of resistance were 4.5% for AMK, 9.1% for LZD, and 13.6% for CLA, respectively. In contrast, resistance to LEV（17/22, 77.3%）, IMI（9/22, 40.9%）, and SMX（10/22, 45.5%） was noted in more than 40% of M. abscessus isolates. DNA sequencing revealed that all the CLA-resistant isolates harbored nucleotide substitutions in position 2058（1/3, 33.3%） or 2059（2/3, 66.7%） of 23 S r RNA. Conclusion In conclusion, our data demonstrated that M. intracellulare and M. abscessus were the most common NTM species in the general hospital of Beijing. CLA, AMK, LZD showed promising activity, where as LEV, IMI, and SMX exhibited poor activity against M. abscessus in vitro.

Lumbar infection caused by Mycobacterium paragordonae:A case report

Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.

Characterization of mycobacterium isolates from pulmomary tuberculosis suspected cases visiting Tuberculosis Reference Laboratory at Ethiopian Health and Nutrition Research Institute,Addis Ababa Ethiopia:a cross sectional study

Objective:To characterize mycobaclerium isolates from pulmomary tuberculosis suspected cases visiting National Tuberculosis Reference Laboratory at Ethiopian Health and Nutrition Research Institute,for diagnosis of pulmonary tuberculosis from January 4 to February 22.2010 with total samples of 263.Methods:Sputum specimens were collected and processed:the deposits were cultured.Por culturing Lowenstein Jensen medium(LJ) and Mycobacteria Growth Indicator Tube(BACTEC MGIT 960) were used.Capilia Neo was used for detecting NTM isolates from isolates of BACTEC MGIT960.In Armauer Hansen Research Institute,Addis Ababa Ethiopia,Deletion typing PCR method for species identification(from confirmed Mycobacterium tuberculosis complex(MTBC) isolates by Capilia Neo) uas done.Results:Out of 263 enrolled in the study.124 and 117 ol them were positive for mycobaeterium growth by BACTEC MGIT 960 and 1.1 culture method,respectively.From BACTEC MGIT 960 positive media of 124 isolates.117 were randomly taken to perform Capilia TB Neo lest.From these 7(6%) of them were found to be NTM and 110(94%) were MTBC.From these 110 MTBC isolates,81 of them were randomly taken and run by the deletion typing RD9 PCR method of molecular technique.Out of these 78(96.3%) were found to be species of Mycobacterium tuberculosis and 3(3.7%) were found to be not in the MTBC.Regarding the types of methods of culture media.Mycobacteria Growth Indicator Tube(BACTEC MGIT 960) method was found to have excellent agreement(with kappa value ol 0.78) with the routine method of LJ.Conclusions:Pulmonary tuberculosis suspected cases visiting the National Tuberculosis Reference Laboratory at EHNR1 that were confirmed to be pulmonary tuberculosis are caused by the species of Mycobacterium tuberculosis.hence treatment regimen including pyrazinamide can be applied to the patients as the first choice in the study area in Addis Ababa.Ethiopia.There is indication of the presence of NTM in patients visiting the tuberculosis reference laboratory and this is important because NTM is known lo cause pulmonary disease similar with sign and symptom ol pulmonary tuberculosis but different in treatment.BACTEC MGIT 960 has excellent agreement with LJ media but it has high tendency of having high contamination rale unless a better decontamination method is designed.

Mycobacterium abscessus infection after facial injection of argireline:A case report

BACKGROUND The incidence of infection with Mycobacterium abscessus(M.abscessus)has increased in recent years.This increase is partly associated with invasive cosmetic procedures.CASE SUMMARY The purpose of this case summary is to increase clinicians'awareness of M.abscessus infection and reduce mycobacterial infection caused by cosmetic procedures.We report the case of a 45-year-old woman who received acetyl hexapeptide-8(argireline)injections in the forehead and temples,and erythema,nodules,and abscesses appeared at the injection sites after one week.The pus specimens were examined by microbiological culture and confirmed to be positive for M.abscessus.Clarithromycin 500 mg twice daily and moxifloxacin 400 mg once daily were administered for 5 mo and the lesions gradually subsided.CONCLUSION We report here for the first time a case of infection with M.abscessus after argireline injection.This condition is easily misdiagnosed as a common bacterial infection.Microbiological examinations are helpful for diagnosis and standardized cosmetic procedures can prevent infection with M.abscessus.

Susceptibility Testing of <i>Mycobacterium frederiksbergense</i>Strains Isolated from Alfalfa Plants against Antibacterial Compounds

Mycobacteria constitute vast population of bacteria that are found in animals, plants and outer environments. Tuberculosis mycobacteria are a group that causes very dangerous diseases for human and animals. Nontuberculous mycobacteria are mainly environmental and are pathogenic in certain circumstances. There are reports of finding mycobacteria in plant tissues, which can be effective to survey in case of different infectious disease issues. In a previous study, we found mycobacteria strains in alfalfa vascular tissues and identified them to species level using 16S rRNA gene sequence analysis, causing some symptoms in plant tissues and aerial parts. As these rapidly growing mycobacteria (RGM) have the potential to cause opportunistic infections in human tissues, one of the most important issues for dealing with these agents is to find the best and most effective drug to treat them. Here, we conducted some assays to investigate the MIC of 7 antibiotics and two antibacterial agents against eight Mycobacterium frederiksbergense alfalfa isolated strains, in order to find the susceptible and resistant ones. We performed susceptibility testing based on broth microdilution method using Mueller hinton broth as the medium used. Results were different among the strains and different resistant and susceptible reactions were observed among different strains against each drug tested, but ethambutol resulted in similar high MIC for all of them. This variability could be attributed to many factors, such as plant tissue composition and developmental stage from which the strains have been isolated, existence and nature of drug targets and other factors such as test conditions and environmental causes. These results can bring us some insights into design and develop new drugs for treating these kinds of organisms, based on the variations in susceptibility reactions and the plant composition effect on them.

Anti-programmed death 1 antibody in the treatment of coexistent Mycobacterium fortuitum and lung cancer: A case report

BACKGROUND Nontuberculous mycobacterium(NTM) refers to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental Mycobacterium. The patients with lung cancer and NTM are somewhat special;the two diseases are inevitably influenced by each other. It brings difficulties and challenges to the choice of treatment. Recently, cancer immunotherapy has been considered one of the pillars for the treatment of lung cancer. However, the clinical experience in the application of immune checkpoint inhibitors is scarce for lung cancer patients with pulmonary tuberculosis, and lung cancer with NTM is even more rare. Although it ameliorates lung cancer, immunotherapy with immune checkpoint inhibitors presents complications of infectious diseases, including tuberculosis and NTM.CASE SUMMARY A 61-year-old male patient visited a doctor in May 2019. His admitting diagnoses were:(1) Cancer of the left lung with a pathological diagnosis of poorly differentiated non-small cell carcinoma, likely poorly differentiated adenocarcinoma, clinical stage Ⅲb(T3N3M0);and(2) Mycobacterium fortuitum(M. fortuitum) infection. We chose to proceed with pembrolizumab treatment. After two treatment cycles, a chest computed tomography scan showed a new irregular subpleural mass in the anterior segment of the left upper lobe of the lung, a reduction in the mediastinal enlarged lymph node, and no other obvious changes. Next, an ultrasound-guided biopsy of the new tumor was performed. Pathological examination showed that a large number of carbon particles were deposited in the alveolar tissue with histiocyte reaction and multinucleated giant cell formation. The tuberculosis(TB) specialist suggested that anti-TB therapy be combined with continued antitumor treatment. The patient continued to be treated with pembrolizumab. After 14 cycles, the lesion shrunk by 79%, there was no recurrence of M. fortuitum infection, and there were no intolerable adverse reactions.CONCLUSION We have observed that in cases of lung cancer complicated with M. fortuitum infection, opportunistic pathogen infection recurrence can be overcome, and immunotherapy is most beneficial when TB doctors and oncologists cooperate to closely observe dynamic changes in M. fortuitum and lung cancer. Treatment should be maintained with low dosage anti-TB drugs after general anti-TB chemotherapy for 1 year;this may prevent opportunistic pathogen infection recurrence during immunotherapy.