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Background: Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus type 2, which is characterized by high infectiousness and diverse clinical manifestations. They are more likely to become critical in people who have underlying diseases or are immunocompromised. In the daunting task of treating patients with COVID-19, those with comorbid fungal infections are susceptible to underdiagnosis or misdiagnosis, which can ultimately lead to increased morbidity and mortality in this group of patients. We report a case of intrapulmonary cavitary lesions after COVID-19, which was eventually diagnosed as pulmonary aspergillosis (PA) by metagenomic Next Generation Sequencing (mNGS) to improve our understanding of the disease. Methods: Appropriate laboratory tests, chest computed tomography (CT), mNGS, and serologic tests were performed for diagnosis. Results: Laboratory tests showed Glactomannan (GM) of 1.41, multiple cavitary lesions in both lungs on chest CT and the presence of aspergillus infection was confirmed by sputum sent for mNGS. Conclusions: In the case of cavitary lesions after COVID-19, we should be alert to the possibility of combined fungi and should promptly perform mNGS to clarify whether there is a combination of specific pathogenic fungal infections. [ABSTRACT FROM AUTHOR]

Background: Pulmonary tuberculosis (PTB) is an important infectious disease that threatens the health and life of human beings. In the diagnosis of PTB, imaging plays a dominant role, but due to the increasing drug resistance of Mycobacterium tuberculosis, atypical clinical manifestations, "different images with the same disease" or "different diseases with the same image" in chest imaging, and the low positivity rate of routine sputum bacteriology, which leads to a high rate of misdiagnosis of PTB. We report a case of pulmonary tuberculosis that was misdiagnosed on imaging. We report a case of pulmonary tuberculosis that resembled sarcoidosis on imaging and was negative for antacid staining on sputum smear and alveolar lavage fluid, and was later diagnosed by microbial next-generation sequencing (NGS). The case was initially misdiagnosed as sarcoidosis. Methods: Alveolar lavage fluid NGS, chest CT, bronchoscopy. Results: Chest CT showed multiple inflammatory lesions in both lungs, multiple nodular foci in both lungs, and multiple enlarged lymph nodes in the mediastinum and hilar region on both sides. Fiberoptic bronchoscopy was performed in the basal segment of the left lower lobe of the lungs to carry out bronchoalveolar lavage, and the lavage fluid was sent to the NGS test and returned the following results: Mycobacterium tuberculosis complex group detected in the number of sequences of 293. Based on the results of the NGS test, the diagnosis of pulmonary tuberculosis could be confirmed. Conclusions: The diagnosis of pulmonary tuberculosis cannot be easily excluded in patients with "different images with the same disease" or "different diseases with the same image" on chest imaging without the support of sputum positivity. The goal was to improve the alertness of medical personnel to the misdiagnosis of tuberculosis and the application of NGS technology. [ABSTRACT FROM AUTHOR]

Background: Carcinoembryonic antigen (CEA) is a polysaccharide complex that is found in the human respiratory system. It is of significant use in disease surveillance of lung cancer; however, serum CEA can occasionally only offer little assistance. We present a case of recurring infection initially diagnosed as carcinoembryonic antigennegative in a patient with a history of hypersensitivity pneumonitis infection, which finally led to the diagnosis of lung adenocarcinoma following percutaneous lung puncture. Methods: Appropriate laboratory tests, chest CT, bronchoscopy, percutaneous lung puncture, and pathologic examination were performed to explore the cause of the disease. Results: Because CEA was negative and a chest CT showed interstitial changes in both lungs with numerous hyperdense shadows, coupled with the patient's history of hypersensitivity pneumonitis, we initially believed that the infection was relapsing. However, a percutaneous lung puncture eventually revealed that the patient had lung adenocarcinoma. Conclusions: Vigilance needs to be increased in clinical work for patients with interstitial lung disease, low tumor markers such as CEA, and imaging suggestive of inflammatory progression, which in fact turns into lung cancer. When the treatment is ineffective after standardized application of hormone and anti-infection, lung tissue should be obtained for pathological examination in time to obtain pathological evidence. [ABSTRACT FROM AUTHOR]

Background: Patients with tuberculous empyema (TE) can have a serious impact on lung function as their disease progresses, and, if left untreated, can cause damage to other parts of the body such as the thorax and spine, causing pain and inconvenience to the patient. Early diagnosis and the search for appropriate treatment are key to improving the survival rate of the disease. Methods: We report a case of a young patient with an unexpected finding of right pleural effusion on physical examination, who was eventually diagnosed with TE using next-generation sequencing of pleural tissue. We analyzed the literature to improve clinicians' understanding of TE and how to properly diagnose and treat the disease. Results: Laboratory results of the pleural effusion suggested a possible Mycobacterium tuberculosis infection, but pathogen-related tests were negative, and the diagnosis was eventually successfully confirmed by thoracoscopic pleural biopsy. Conclusions: The diagnosis of TE should be considered in young patients with pleural thickening of the empyema. Adenosine deaminase may provide diagnostic direction in patients with unexplained thorax abscess. Pleural biopsy, although an invasive procedure, is an essential diagnostic tool in some cases. [ABSTRACT FROM AUTHOR]

Background: Herpesvirus IgG antibody positivity can be a lifelong burden of disease replication and reinfection or recent viruses can be reactivated and play an important role in the diagnosis and monitoring of herpesvirus [1]. However, sometimes serum IgG antibody positivity is of limited help in determining the onset of disease. We reported a case of herpesvirus IgG antibody positive in a patient with lung cancer who was initially misdiagnosed as herpes simplex and later confirmed drug-induced pemphigus (DIP) by histological and immunofluorescence studies. Methods: Appropriate laboratory tests, enzyme-linked immunosorbent assay (ELISA), immunofluorescence and histological tests were performed for diagnosis. Results: In lung cancer patients who were positive for herpesvirus IgG antibodies, were initially misdiagnosed as herpes simplex and eventually confirmed by histological and immunofluorescence examinations as DIP. Conclusions: Positive herpesvirus IgG antibody is not a specific manifestation of herpesvirus infection. For patients with unexplained skin blisters, we should improve histological examinations as soon as possible to clarify the type of lesion. [ABSTRACT FROM AUTHOR]

Background: Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung cancer, especially small cell lung cancer, but sometimes serum NSE provides limited help. We report a case of high-density shadow of the left lung and elevated serum NSE which mimicked lung cancer. It was ultimately confirmed to be pulmonary aspergillosis (PA) by bronchoscopic alveolar lavage fluid (BALF) and next-generation sequencing (NGS). Methods: Appropriate laboratory tests, chest computed tomography (CT) scan, bronchoscopic alveolar lavage fluid, and next-generation sequencing were used to explore latent causes. Results: NSE level was elevated, chest CT scan showed high-density shadow of the left lung, bronchoscopy showed flesh-colored new organisms in the lower lobe of the left lung, BALF and NGS revealed the presence of Aspergillus. Conclusions: Elevated NSE is not a typical manifestation of lung cancer, and we should perform BALF and NGS early to determine whether there is infection with special pathogenic bacteria. [ABSTRACT FROM AUTHOR]

Background: Carcinoembryonic antigen (CEA) is a polysaccharide complex present in the human respiratory system, which can reflect the presence of tumors in the human body and has important value in the monitoring of lung cancer [1], but sometimes serum CEA provides limited help. We reported a case of multiple consolidation of the lungs with elevated serum CEA, initially misdiagnosed as lung cancer and eventually confirmed by bronchoscopic lung biopsy as pulmonary cryptococcosis (PC). Methods: Appropriate laboratory examination, chest computed tomography (CT) scan, and bronchoscopy lung biopsy were used to explore the latent etiology. Results: CEA level was elevated, chest CT scan showed multiple consolidation of the lungs, serum cryptococcal antigen was positive, and pathological findings on bronchoscopic lung biopsy confirmed pulmonary cryptococcosis. Conclusions: Elevated CEA is not typical of lung cancer. We should also consider the possibility of specific pathogenic infection. Bronchoscopic lung biopsy is the gold standard should be performed as soon as possible to identify the lesion. [ABSTRACT FROM AUTHOR]

Background: Acute Eosinophilic Pneumonia (AEP) is a rare form of non-infectious pneumonia that is easily missed and misdiagnosed because of its atypical clinical symptoms and misleading laboratory and imaging studies. Methods: By reporting a case of an initial diagnosis of lung abscess, which was treated with antibiotics and then CT suggesting that the lesion continued to worsen, it was eventually confirmed to be AEP by lung biopsy, A joint literature analysis was conducted to improve clinicians' understanding of the diagnosis and treatment of AEP. Results: Initially, because of the atypical ancillary findings, we thought the disease was a lung abscess, which was eventually confirmed by pathology as AEP. Conclusions: The presence of AEP needs to be considered when various laboratory findings point to infectious disease, but anti-infection is not effective. Diagnosis can be confirmed by bronchoalveolar lavage and lung tissue biopsy. Prompt treatment can provide rapid relief and reduce the risk of patient death. [ABSTRACT FROM AUTHOR]

Background: Current studies have reported that it is rare for the coronavirus disease 2019 (COVID-19) to be combined with two fungal infections and that COVID-19 can be combined with multiple cardiovascular complications, both of which can complicate the condition and increase the risk of death. Methods: We report a case of COVID-19 in which Aspergillus fumigatus and Cryptococcus neoformans were detected by sputum targeted next-generation sequencing (tNGS) and cardiac monitoring during treatment revealed cardiovascular complications. Results: We consider that this patient's fungal infection was associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the application of corticosteroids. In addition, cardiovascular complications were associated with an inflammatory response and increased sympathetic stimulation due to SARS-CoV-2 infection. Conclusions: The presence of COVID-19-associated fungal infections cannot be excluded when multiple risk factors for fungal infections are present in patients with COVID-19 and the condition is rapidly deteriorating. Effective long-term monitoring of cardiac function during the patient's hospitalization is necessary to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Infectious pulmonary diseases caused by nontuberculous mycobacteria (NTM) are becoming more common in clinical work, and early detection of the bacterium and its early identification are prerequisites for accurate treatment. Methods: By reporting a case of confirmed NTM infection in a patient with connective tissue disease-associated interstitial lung fibrosis, a joint literature analysis was performed to improve clinicians' understanding of NTM and the clinical application of targeted next-generation sequencing (tNGS). Results: Chest CT suggested a partially enlarged cavitary lesion in the upper lobe of the right lung, combined with positive sputum antacid staining, and sputum tNGS was sent to confirm the final diagnosis of Mycobacterium paraintracellulare infection. Conclusions: The successful application of tNGS helps in the rapid diagnosis of NTM infection. It also reminds medical practitioners to consider the presence of NTM infection in advance in the presence of many NTM infection factors, combined with imaging manifestations. [ABSTRACT FROM AUTHOR]

Background: Organizing pneumonia (OP) is a pathologic concept characterized by the formation of granulation tissue from fibroblasts, myofibroblasts, collagen, and fibrotic exudate in the respiratory fine bronchi, alveolar ducts, and alveoli. The clinical imaging of mechanized pneumonia is variable, and histopathological examination is required to clarify the nature of the lesion when imaging is atypical. We report a case of OP with imaging resemblance to pulmonary tuberculosis and false-positive next-generation sequencing (NGS), which was first misdiagnosed as pulmonary tuberculosis. Methods: Appropriate laboratory tests, alveolar lavage fluid NGS, chest CT, bronchoscopy, percutaneous lung puncture, pathology. Results: Chest CT showed a nodular high-density shadow in the lower lobe of the right lung. According to the chest CT, bronchoalveolar lavage was performed in the dorsal segment of the right lower lobe of the lung. NGS of lavage fluid: the sequence number of Moraxella osseae was 1,423; the sequence number of Prevotella melanogaster was 1,129. Based on lung histopathology, fibrous emboli and necrotic material were seen in the alveolar lumen, and the final diagnosis of the OP was confirmed. Conclusions: It should be noted that physicians should not blindly believe the NGS result report. When the diagnosis is not clear and anti-infection treatment is ineffective, lung tissue should be obtained promptly for pathological examination to obtain pathological evidence to differentiate from misdiagnosed diseases. [ABSTRACT FROM AUTHOR]

Background: Pulmonary tuberculosis presenting as solitary pulmonary nodules in imaging is sometimes difficult to differentiate from lung cancer and is more likely to be misdiagnosed when accompanied by elevated CEA and positive PET-CT findings. Methods: By reporting a case of misdiagnosed lung cancer, which was confirmed to be pulmonary tuberculosis by lung biopsy, a joint literature analysis was performed to raise clinicians' awareness of isolated nodules in the lung. Results: With a series of ancillary tests, we initially considered the nodule to be malignant, and the lung biopsy pathology eventually confirmed pulmonary tuberculosis. Conclusions: When chest imaging suggests the presence of malignant features in solitary pulmonary nodules, invasive procedures can be performed appropriately to clarify the nature of the lesion. The diagnosis cannot be made blindly to ensure that no incorrect diagnosis is made nor wrong treatment given. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) causes fewer infections, and it causes invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) that can lead to a poor prognosis for patients. Methods: Next-generation sequencing (NGS), sputum culture, drug sensitivity test, and other examination methods can detect the specific situation of pathogens in advance. Results: The patient was determined to have CR-hvKP infection after NGS, sputum culture, and drug sensitivity test, and improved after treatment. Conclusions: When antibiotics are applied in the presence of infection but symptoms do not improve, relevant laboratory or other tests should be performed promptly, and the selection of appropriate antibiotics may improve the survival rate of patients. [ABSTRACT FROM AUTHOR]