Metagenomic testing successfully diagnosed complex pneumonia case

A 54-year-old man with nephrotic syndrome, an immunocompromised condition, was admitted to the hospital due to severe community-acquired pneumonia (SCAP). He developed symptoms like cough, chest pain, and fever after receiving inadequate treatment at a local clinic. Upon arrival at Guizhou Provincial People’s Hospital, his examinations revealed low respiratory sounds and wet rales in both lungs. He had a high temperature and difficulty breathing. Despite extensive tests, initial results were inconclusive, and chest CT scans showed severe lung lesions and lymph node enlargement. The doctors suspected a severe infection caused by multiple pathogens due to the patient's compromised immune system. He was treated with a combination of antibiotics and antiviral medicine. Over time, the patient started to improve; however, he continued to experience fever and mild symptoms. Further tests using a new method called metagenomic next-generation sequencing (mNGS) revealed a rare co-infection with five pathogens, including Nocardia farcinica and Aspergillus fumigatus. The treatment was adjusted based on these findings, and the patient's condition improved significantly. By the 21st day, he showed no major symptoms and was discharged for further oral treatment. This case is notable as it is the first documented instance of such a combination of pathogens causing pneumonia in a patient with SCAP. It highlights the challenges in diagnosing and treating complicated infections, particularly in immunocompromised patients. The use of mNGS demonstrated its effectiveness in identifying difficult-to-detect pathogens, emphasizing the importance of advanced diagnostic techniques in managing severe infections.