Tsukamurella pneumonia misdiagnosed as pulmonary tuberculosis

A 72-year-old man, with a 10-year history of oral dexamethasone (5 mg once a day) for intermittent pneumonia, had been previously hospitalised due to cough, expectoration, and chest tightness for approximately 9 months. In his previous hospitalisation, 3 months before admission to the Chest Hospital of Hebei Province (Shijiazhuang, China), a chest CT scan showed left pyopneumothorax and a cavity in the right upper lobe, a purified protein derivative skin test was positive, and a sputum smear showed acid-fast bacilli; however, the sputum nucleic acid amplification test for Mycobacterium tuberculosis was negative. The patient was initially diagnosed with pulmonary tuberculosis and underwent a closed thoracic drainage and anti-tuberculosis chemotherapy, including oral pasiniazide (0·50 g twice a day), oral rifapentine (0·60 g twice a week), oral pyrazinamide (0·50 g three times a day), and oral ethambutol (0·75 g once a day).