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case_images: Chest computed tomography (CT) scans of the patient on July 4, 2017. (A) scattered large nodular shadows in the upper lobes of both lungs; (B) thickening and calcification of the left pleural apex.
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case_images: On July 4, 2017, chest CT showed scattered large nodular shadows in the upper lobes of both lungs, thickening and calcification of the left pleural apex, which cannot exclude the possibility of tuberculosis (Figures 1 and 2).
case_images: Serial chest computed tomography (CT) scans of the patient. (A and B) July 4, 2017. (C and D) November 9, 2022. (E and F) March 2, 2023.
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case_images: On July 4, 2017, chest CT showed scattered large nodular shadows in the upper lobes of both lungs, thickening and calcification of the left pleural apex, which cannot exclude the possibility of tuberculosis (Figures 1 and 2). Chest CT showed nodules in both lungs and cavity formation in the posterior segment of the upper lobe of the left lung (Figure 2), indicating possible secondary pulmonary infection with Mycobacterium tuberculosis (TB). On March 2, 2023, the patient was reviewed again and the chest CT illustrated increased texture diffuse and nodular shadow in both lungs with symmetrical distribution, and cavitation shadow in the posterior segment of the upper lobe of the left lung showing no significant change compared before (Figure 2).
case_images: Chest X-ray of the patient on May 14, 2018. Extensive interstitial changes in both lungs: posteroanterior view (A) and lateral view (B).
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case_images: On May 14, 2018, chest X-ray showed extensive interstitial changes in both lungs, suggesting possible interstitial fibrosis (Figure 3).
case_images: Bronchoscope imaging of the patient. The typical bronchoscopy findings were scattered mucous sputum in the lumen. (A) Protuberance; (B) opening of upper and lower lobe of left lung; (C) opening of upper lobe of left lung; (D) upper branch of upper lobe of left lung.
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case_images: The scattered mucous sputum in the lumen can be seen (Figure 4), suggesting the possibility of infectious lesion.
case_images: The microbiological tests of Mycobacterium europaeum. (A) Metagenomic next-generation sequencing results of patient. 6757 M. europaeum specific sequences covered 7.19% of the total M. europaeum genome, which was detected by mNGS in the BLAF sample; the BALF culture (B) and acid-fast bacilli (AFB) smears (C) of the M. europaeum.
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case_images: To further clarify the diagnosis, we communicated with the patient and sent BALF for mNGS assay. mNGS results reported Mycobacterium europaeum (6757 reads) (Figure 5), Moraxella catarrhalis (64 reads), and human herpesvirus type 4 (1598 reads). BALF was acquired again at the same site and sent to culture, which returned positive results for Mycobacterium spp. (Figure 5).  