Pulmonary tuberculosis or nocardiosis? A clinical case discussion

The examination and treatment of patients with pulmonary tuberculosis lacking bacteriological confirmation can be challenging due to the absence of data on the pathogen species and its drug susceptibility. Since several lung diseases present with clinical and radiological features similar to tuberculosis, identifying the etiological agent is crucial.
This article discusses the utility of microbial marker mass spectrometry (MSMM) and 16S rRNA sequencing technologies for establishing disease etiology, illustrated by a clinical case of a patient diagnosed with pulmonary tuberculosis without bacteriological confirmation. During further examination using MSMM, 10-methyloctadecanoic acid, a marker of the order Mycobacteriales, was detected in the patient’s sputum and bronchial lavage samples. Subsequently, 16S rRNA sequencing revealed the DNA of Nocardia cyriacigeorgica. These results indicate the need to broaden diagnostic capabilities in cases where standard microbiological methods fail to establish the etiology of the disease.

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