Peripheral pulmonary tuberculoma diagnosed by targeted next-generation sequencing with manual mapping navigation: A case report.

RATIONALE: Pulmonary tuberculoma is a special type of tuberculosis, and tuberculoma located in the peripheral part of the lung tend to be confused with other pulmonary diseases such as peripheral lung cancer, so early diagnosis is challenging. Manual mapping navigation defined as freehand sketching of bronchial routes based on computed tomography (CT) images. Bronchoscopists use this technique to assist in alveolar lavage and histological acquisition of peripheral lung lesions. We report a case of a patient who was ultimately diagnosed with peripheral tuberculoma of the lung after bronchoscopic tissue biopsy and targeted next-generation sequencing (tNGS) by manual mapping navigation. PATIENT CONCERNS: A 29-year-old man was hospitalized for a solid nodule of about 27 mm × 20 mm subpleural in the basal segment of the right lower lobe detected on CT screening. DIAGNOSES: The patient's CT results suggest that the nature of the nodule is undetermined. INTERVENTIONS: The patient underwent bronchoscopic biopsy, brushing, and bronchoalveolar lavage fluid for tNGS testing guided by manual mapping navigation, which was subsequently diagnosed as pulmonary tuberculoma. OUTCOMES: Pathological results suggested lymphocytic infiltration, interstitial fibrous tissue hyperplasia, and tuberculosis-causing mycobacterium complex was detected in bronchoalveolar lavage fluid by tNGS. Finally, the patient was transferred to a tuberculosis specialty hospital for ***antituberculosis treatment, and the CT scan was repeated to show the nodule was smaller. LESSONS: Diagnosis of peripheral pulmonary lesions is challenging, however, the use of a manual mapping navigation system in combination with tNGS can help in the diagnosis of most lung lesions in institutions that cannot provide advanced bronchoscopy techniques.