A case of non-cystic fibrosis bronchiectasis associated with nontuberculous mycobacteria and Pseudomonas aeruginosa infection diagnosed by metagenome sequencing

This report describes a 68-year-old woman with non-cystic fibrosis bronchiectasis (“bronchiectasis”) associated with nontuberculous mycobacteria (NTM) infection. She presented with cough, expectoration, bronchiectasis, and a negative QuantiFERON tuberculosis (QFT) test. But her sputum and bronchoalveolar lavage fluid (BALF) tested acid-fast bacilli (AFB) positive. The patient had a nine-year history of autoimmune liver disease and was diagnosed with liver cirrhosis for 1 year. Metagenomics next generation sequencing (mNGS) of her BALF sample reported positive for NTM and Pseudomonas aeruginosa (PA). According to the patient's clinical features and consultations with respiratory and tuberculosis specialists, the patient was not prescribed anti-tuberculosis treatment. Rather, her symptoms improved with anti-PA treatment. This case report also emphasizes the importance of avoiding anti-tuberculosis treatment immediately after an initial diagnosis of non-tuberculous mycobacterial pneumonia.report also emphasizes the importance of avoiding anti-tuberculosis treatment immediately after an initial diagnosis of non-tuberculous mycobacterial pneumonia.