Objective:

To describe a rare case of pulmonary infection caused by Mycobacterium abscessus in an infant and evaluate the complementary diagnostic value of metagenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS) in identifying non-tuberculous mycobacterial (NTM) infections when conventional testing is inconclusive.

Approach:

Key Findings:

• mNGS provided an initial diagnostic clue with a single read of M. abscessus.
• tNGS identified a significant number of reads of M. abscessus subsp. massiliense, confirming the diagnosis.
• Histopathological examination showed granulomatous inflammation consistent with NTM infection, including multinucleated giant cells.

Interpretation:

Limitations:

• The low bacillary load in NTM infections can limit the effectiveness of mNGS.
• mNGS may not reliably achieve species-level identification or provide resistance-related data.

Conclusion:

This case illustrates the integration of mNGS and tNGS for identifying atypical pulmonary lesions caused by NTM in infants.

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