A case of a combination of mycobacterial infection in a patient with etiologically unidentified lung dissemination

Background. Disseminated pulmonary lesions pose one of the most challenging diagnostic problems in pulmonology and phthisiology. Mycobacterial infection — both tuberculous and non-tuberculous — frequently mimics other interstitial lung diseases, leading to significant diagnostic delays and epidemiological risk, particularly when healthcare workers serving vulnerable populations are affected.
Objective. To present a case illustrating the diagnostic challenges of timely etiological verification of combined mycobacterial infection in a healthcare worker with pulmonary dissemination of undetermined etiology.  
Case Report. A 55-year-old female nurse working with pediatric patients was followed as an outpatient for one year with pulmonary infiltrates of unknown origin, despite multiple specialist consultations. Upon admission to a specialized institution and exhaustion of non-invasive diagnostic options, video-assisted thoracoscopic surgery (VATS) with lung resection was performed for diagnostic and therapeutic purposes. Histopathological examination of the resected specimen revealed features consistent with tuberculosis; subsequent mycobacterial culture additionally confirmed non-tuberculous mycobacterial infection. A comprehensive multidisciplinary approach enabled rapid diagnosis and initiation of targeted therapy.
Conclusion. This case underscores the importance of early referral of patients with undiagnosed pulmonary dissemination to specialized phthisiopulmonology centers equipped with the full range of invasive diagnostic modalities, including VATS biopsy and extended mycobacterial identification.

1. Global tuberculosis report 2024. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.

2. Chumovatov N.V., Tarasov R.V. A long-term tuberculosis process with a drug-resistant pathogen under the guise of lung sarcoidosis. Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH). 2025;15(2):160-164. (In Russ.). https://doi.org/10.20340/vmi-rvz.2025.2.CASE.1

3. Teibo TKA, Andrade RLP, Rosa RJ, de Abreu PD, Olayemi OA, Alves YM, Vaz Tavares RB, da Costa FBP, Dias Moura HS, Ferezin LP, Tártaro AF, de Campos MCT, Ribeiro NM, Berra TZ, Arcêncio RA. Barriers That Interfere with Access to Tuberculosis Diagnosis and Treatment across Countries Globally: A Systematic Review. ACS Infect Dis. 2024 Aug 9;10(8):2600-2614. https://doi.org/10.1021/acsinfecdis.4c00466

4. Chelnokova O.G., Golovanova M.N., Senin I.G. Features of the Perception of the Problem of Tuberculosis by Primary Health Care Physicians. Tuberculosis and Lung Diseases. 2020;98(1):41-45. (in Russ.). https://doi.org/10.21292/2075-1230-2020-98-1-41-45

5. Adane K, Spigt M, Johanna L, Noortje D, Abera SF, Dinant GJ. Tuberculosis knowledge, attitudes, and practices among northern Ethiopian prisoners: Implications for TB control efforts. PLoS One. 2017 Mar 30;12(3):e0174692. https://doi.org/10.1371/journal.pone.0174692

6. Golub JE, Bur S, Cronin WA, Gange S, Baruch N, Comstock GW, Chaisson RE. Delayed tuberculosis diagnosis and tuberculosis transmission. Int J Tuberc Lung Dis. 2006 Jan;10(1):24-30. PMID: 16466033.

7. Ratnatunga CN, Lutzky VP, Kupz A, Doolan DL, Reid DW, Field M, Bell SC, Thomson RM, Miles JJ. The Rise of Non-Tuberculosis Mycobacterial Lung Disease. Front Immunol. 2020 Mar 3;11:303. https://doi.org/10.3389/fimmu.2020.00303

8. Hermansen TS, Ravn P, Svensson E, Lillebaek T. Nontuberculous mycobacteria in Denmark, incidence and clinical importance during the last quartercentury. Sci Rep. 2017 Jul 27;7(1):6696. https://doi.org/10.1038/s41598-017-06931-4

9. Lange C, Bothamley G, Günther G, Guglielmetti L, Kontsevaya I, Kuksa L, Lange B, Lorent N, Saluzzo F, Sester M, Tebruegge M, Tunesi S, Tweed C; Tuberculosis Network European Trials group (TBnet). A Year in Review on Tuberculosis and Non-tuberculous Mycobacteria Disease: A 2025 Update for Clinicians and Scientists. Pathog Immun. 2025 Mar 2;10(2):1-45. https://doi.org/10.20411/pai.v10i2.791