Diagnosing non-tuberculous mycobacterial pulmonary disease (NTM-PD) in patients unable to produce sputum spontaneously requires invasive procedures to obtain valid respiratory specimens. In this retrospective study, we evaluated the results of microbiological tests performed on respiratory samples of 132 patients affected by NTM-PD. In the diagnostic workout, 98 patients performed both induced sputum (IS) and bronchoalveolar lavage (BAL) and were enrolled in our study. A total of 93 out of 98 BAL samples (95%) were culture-positive for mycobacteria, whereas only 67/153 (44%) induced sputum cultures were positive for NTM (p < 0.001). Molecular identification of NTM with real-time polymerase chain reaction (PCR) was positive in 48/64 BAL (75%) and in 47/139 (34%) IS samples (p < 0.001). Patients affected by nodular-bronchiectatic form were 65/98 (66%): BAL culture was positive in 95% of cases (62/65 BAL), while only 30/99 IS cultures were positive (30%; p < 0.001). PCR was positive in 76% of BAL samples examined (26/34) and in 26% of the IS samples (24 out of 91) (p < 0.001). Among 33 patients with a fibro-cavitary radiological pattern, 65% of IS (35/54) were culture-positive for NTM, whereas 94% of cases (31/33) had a positive culture for NTM from BAL (p = 0.002). PCR was positive in 73% of BAL samples tested (22/30) and 48% of IS samples tested (23/48) (p = 0.031). Our results confirm BAL mycobacterial culture as the gold standard for the diagnosis of pulmonary mycobacteriosis. FBS with BAL should be performed in every patient with a strong suspicion of NTM-PD, if other respiratory samples are repeatedly negative. Sputum induction is a useful technique to obtain valid respiratory samples when patients are unable to produce spontaneous sputum, especially in the outpatient setting. However, during the diagnostic workup of NTM-PD, we should not forget that PCR and mycobacterial culture of induced sputum have a lower yield than when performed on BAL, especially in the nodular-bronchiectatic form of the disease.

We report here a case of a patient affected by B-cell chronic lymphocytic leukemia (CLL) that developed COVID-19 during the actual SARS-CoV-2 outbreak. The coexistence of CLL and COVID-19 raises many questions regarding the possible increased risk of developing COVID-19 among patients with CLL, the problems in managing therapies for both diseases and, above all, the difficulties in diagnosing COVID-19 in patients affected by CLL. In our patient, an 84-year-old man, the recognition of COVID-19 was delayed because of its atypical clinical presentation and technical problems related to the methods used for the diagnosis. Based on the symptoms and the radiological aspect of the lung, the occurrence of COVID-19 was suspected. Repeated tests on oro/nasopharyngeal swabs gave negative results, causing a delay in the diagnosis. Moreover, different methods used to identify the SARS-CoV-2 antibodies in serum gave conflicting results, and only two tests were able to identify SARS-CoV-2 Abs of the IgG type. During the clinical course of unrecognized COVID-19, our patient developed severe complications and did not receive any specific treatment for the two diseases. Recognition of COVID-19 in patients with CLL is a challenging task and the most accurate methods are necessary to overcome the diagnostic difficulties encountered.

Background: Interstitial lung diseases (ILDs) are a heterogeneous group of conditions that can cause fibrosis of the lung interstitium, resulting in respiratory failure and death. Patients with an ILD, particularly idiopathic pulmonary fibrosis (IPF) or connective tissue disease-associated ILDs (CTD-ILDs), are prone to develop chronic pulmonary infections such as tuberculosis (TB) and non-tuberculous mycobacterial pulmonary disease (NTM-PD). Methods: This case series examines the management of three ILD patients with a usual interstitial pneumonia (UIP) pattern and concomitant NTM-PD or TB at National Institute for Infectious Diseases “Lazzaro Spallanzani” in Rome, Italy, over three years (2019–2022). Results and Conclusions: Multi-disciplinary discussion (MDD) was crucial to define the therapeutic approach due to the increased risk of side effects and drug interactions. Our work underscored how a comprehensive diagnostic evaluation, enriched by MDD, is useful for optimizing the management and reducing drug-related adverse effects and interactions in ILD patients with cavitary lesions.

A 59-year-old patient without a history of pulmonary disease presented with episodes of hemoptysis and acute respiratory failure after being treated for metastatic breast cancer with fulvestrant and palbociclib. The high-resolution chest CT revealed diffuse ground glass opacities and diffuse smooth thickening of the interlobular septa and peribronchovascular interstitium, consistent with drug-induced interstitial lung disease (DIILD). A few days of high-dose steroid treatment increased the patient's PaO2/FiO2 from 75 to 200. Following hospital discharge, the oncologist resumed fulvestrant therapy, with no further adverse events occurring during subsequent follow-up.

Background: Superficial cervical lymphadenopathy frequently requires tissue sampling because infectious, inflammatory, and malignant diseases often share overlapping clinical and radiological features. Although ultrasound-guided sampling of superficial cervical lymph nodes is well established, the available literature predominantly focuses on fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB). Comparatively less data specifically describe aspiration-based tissue acquisition providing material for combined histopathological, microbiological, and molecular analyses, particularly in very small cervical lymph nodes. We describe our single-center experience with ultrasound needle aspiration biopsy (US-NAB), focusing on technical feasibility, sample adequacy, diagnostic contribution, and procedural safety. Methods: We retrospectively analyzed 20 consecutive patients referred to a tertiary respiratory infectious diseases center between April 2023 and June 2024 for suspected cervical tuberculous lymphadenopathy. All patients underwent real-time US-NAB using an 18-gauge modified Menghini aspiration needle. Biopsy specimens were processed, as applicable, for histopathology, acid-fast bacilli smear microscopy, molecular testing (real-time PCR), and mycobacterial culture. Diagnostic yield, final diagnoses, lymph node size, and procedural safety were evaluated. Results: A final diagnosis of tuberculosis was established in 13 patients (65%), while seven patients (35%) received alternative diagnoses, including metastatic malignancies (20%), sarcoidosis (10%), and bacterial lymphadenitis (5%). Adequate material contributing to a definitive diagnosis was obtained in all 20 procedures (20/20). Notably, 60% of sampled lymph nodes measured <15 mm in short-axis diameter, including two nodes measuring only 5–6 mm. Histopathology was diagnostic of tuberculosis in eight patients, whereas five additional cases with nonspecific necrosis were confirmed by positive TB-PCR. No major procedure-related complications, including bleeding, pneumothorax, or pneumomediastinum, were observed. Conclusions: In this small single-center cohort, US-NAB was feasible and safe and provided adequate material for histopathological, microbiological, and molecular analyses, including when very small superficial lymph nodes were sampled. Beyond confirming tuberculosis, the procedure contributed to the identification of alternative benign and malignant diagnoses. These findings support further evaluation of US-NAB as a complementary sampling option in the diagnostic work-up of superficial cervical lymphadenopathy.

In Italy, tuberculosis (TB) incidence in the last decade has remained constant at under 10 cases/100,000 inhabitants. In the Philippines, TB annual incidence is greater than 500 cases/100,000 inhabitants. Omalizumab is a humanized anti-IgE monoclonal antibody approved for the treatment of chronic spontaneous urticaria. We report the case of a 32-year-old Filipino woman who suffered from chronic urticaria, treated with topic steroids since June 2022 and systemic steroids for 2 weeks. In November 2022, she started omalizumab therapy at a monthly dose of 300 mg; she was not screened for TB infection. In the same month, a left laterocervical lymphadenopathy arose, which worsened in February 2023 (diameter: 3 cm). The patient recovered in April 2023 in INMI “Lazzaro Spallanzani” in Rome for suspected TB. Chest CT showed a “tree in bud” pattern at the upper-right pulmonary lobe. The patient tested positive for lymph node biopsy molecular tuberculosis. The patient started standard antituberculosis therapy. She discontinued omalizumab. To our knowledge, this is the second diagnosed TB case during omalizumab treatment, which suggests that attention should be paid to the known risk of TB during biotechnological treatments. Even if current guidelines do not recommend screening for TB before starting anti-IgE therapy, further data should be sought to assess the relationship between omalizumab treatment and active TB. Our experience suggests that screening for TB should be carried out in patients from highly tuberculosis-endemic countries before starting omalizumab therapy.