Cavitary Lung Disease Research Articles

A Study of Clinical, Radiological, and Etiological Profiles of Patients with Cavitary Lung Disease

Abstract Background: This study aims to find out the distribution pattern of cavitary lung disease across clinical, radiological, and etiological variables. Methods: This is an observational monocentric retrospective study conducted in Apollo Hospital, Greams Road, Chennai, between August 2022 and May 2023. After excluding cases lacking follow-up and no clinical data, 50 patients with cavitary lung disease who underwent bronchoscopy were included in this study. Data such as demographics, smoking status, clinical presentation, comorbidities, and radiological features were obtained. Results: Of the 50 participants, the majority had tuberculosis (TB), fungal, and bacterial infections. Fungal cavities were common in males with uniform age distribution and had cavities with air crescent signs. Bronchoscopy was inconclusive in most of them and required either computed tomography or video-assisted thoracic surgery (VATS)-guided biopsy to establish a diagnosis. The most common malignancy was squamous cell carcinoma, and autoimmune disease was granulomatous polyangiitis. Conclusion: Our study shows that the presence of cavities points more toward TB. One of the key measures in making TB treatment and control activities a success is identifying patients at high risk of transmission and poor outcomes like patients with cavities. However, it is important to exclude other diagnoses like malignancy where the prognosis can be fatal.

Granulomatosis with polyangiitis masquerading as disseminated tuberculosis in presence of bilateral lung cavities and hemorrhagic infarct

Lung cavitations with constitutional symptoms are usually associated with pulmonary tuberculosis due to its high prevalence and are the most common infectious cause in India. Granulomatosis with polyangiitis (GPA) with the systemic pulmonary disease will have different radiological presentations such as nodule, mass, and consolidation with or without cavitation. In this case report, we have reported a 40-year-old female presented with cough, fever, and weight loss of 6 months duration with chest imaging suggestive of bilateral cavitary lung disease. She was labeled as a case of disseminated tuberculosis due to involvement of the central nervous system and empirically treated with anti-tuberculosis treatment (ATT) without microbiological evidence of tuberculosis in smear and cartridge-based nucleic acid amplification tests. The absence of clinical response and radiological worsening to empirical ATT gives a clue for an alternate diagnosis. Bronchoscopy workup documented Aspergillus colonization and vasculitis workup in the presence of cavitary lung disease documented abnormally raised proteinase 3 anti-neutrophil cytoplasmic antibodies titers. She was treated with a combination of systemic methylprednisolone and azathioprine with voriconazole. Her clinical response was observed in 4 weeks and radiological response with complete radiological clearance of pulmonary cavitations was documented after 6 months of treatment. We recommend prompt workup and ruling out GPA in all cases with pulmonary cavitations with negative microbiological workup and no empirical ATT should be given in the era of rapid microbiological tests with good sensitivity and specificity.

Cavitary Lung Disease with Constitutional Symptoms Misinterpreted & Treated as a Bronchial Asthma and Enteric Fever for a Long Period: What are Timings from Infection to Cavitation in Tuberculosis? Revisits Wallgren’s timetable !

Cavitary Lung Disease with Constitutional Symptoms Misinterpreted & Treated as a Bronchial Asthma and Enteric Fever for a Long Period: What are Timings from Infection to Cavitation in Tuberculosis? Revisits Wallgren’s timetable !

Role of Multidetector Computed Tomography in Differentiation of Benign and Malignant Cavitary Lung Lesions With a Histopathological Correlation: A Retrospective Cross-Sectional Study.

Introduction Cavitary lung disease has a wide range of differential diagnoses, which include both benign and malignant lesions. Imaging differentiation of benign from malignant cavitary lesions has always been a challenge due to overlapping imaging findings. The present study describes the most accurate multidetector computed tomography (MDCT) findings that could help in differentiating benign from malignant conditions in correlation with the histopathological reports. Methods This retrospective study was carried out on diagnosed cases of cavitary lung lesions on MDCTfrom January 2022 to February 2023. We evaluated the number of cavitary lung lesions, their location with respect to lung segment/lobe, the maximum diameter of the largest lesion, the maximum wall thickness of the largest cavity, and additional findings associated with these lesions. Measurements of the maximum wall thickness were plotted on a graph. Statistical analysis was done, and a receiver operating characteristic curve (ROC) was calculated to find the accurate cut-off wall thickness for malignant and non-malignant lesions.These findings were then correlated with the histopathological report. Results A review of the MDCT scans of 47 patients was done; 30 (63.8%) of those were male with a mean age of 47.93±14.68 (SD) years while 17 (36.2%) were female with a mean age of 52.53 ±18.38 (SD) years. Out of 47 patients, 27 (57.4%) had benign lesions and 20 (42.5%) had malignant lesions. Significant differences (p<0.05) were found between benign and malignant lesions while comparing the averages of maximum wall thickness (8.1 mm and 14.5 mm, respectively) and the irregular inner margin of the largest cavitary lesions. The presence of consolidation and centrilobular nodules correlated significantly (p<0.05) with the benign nature of cavitary lung lesions. The maximum cut-off wall thickness was <6 mm and >17 mm for the differentiation of benign from malignant lung lesions, respectively. Conclusions The maximum wall thickness and irregular inner margin of cavitary lung lesions was a good indicator for the differentiation of benign and malignant etiologies on MDCTwhile consolidation and centrilobular nodules favoured the benign etiology more.

Satellite Nodules with Pericavitary Consolidation Presenting As ‘Black Hole in the Starry Sky Pattern’ in HRCT Thorax: A Strong Predictor of Active Pulmonary Tuberculosis!

Pulmonary tuberculosis is the most common cause for cavitary lung disease in India. Radiological presentations in pulmonary tuberculosis are different and mainly depend on the immune status of hosts, durations of illness and underlying comorbidities. Consolidation, cavitation, pleural effusion, airways disease and lymphadenopathy are frequently reported in thoracic tuberculosis. In this case report, a 36-year male, presented with constitutional symptoms for 4 months duration with partial response to medical treatment received according to their knowledge and experience towards pneumonia, bronchial asthma and bronchitis. Radiological investigations documented inhomogeneous nodular infiltrates in the left upper zone which was underestimated due to presence of crepitations and wheeze. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax due to nodular opacities and persistent symptoms and documented black hole in the starry sky pattern’ which is first time described in medical literature. ‘Blackhole in starry sky pattern’ is described in the present case as a giant lung cavity mimicking black hole and a satellite nodule mimicking a starry sky pattern. Satellite nodules are defined as ill-defined to well demarcated nodular opacities with or without conglomeration around tuberculous consolidation or cavity. We have done induced sputum microbiological workup and documented acid-fast bacilli in sputum smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms with Satellite nodules with pericavitary consolidation presenting as ‘black hole in the starry sky pattern’ in HRCT thorax to have successful treatment outcome.

Satellite Nodules with Pericavitary Consolidation Presenting As ‘Black Hole in the Starry Sky Pattern’ in HRCT Thorax: A Strong Predictor of Active Pulmonary Tuberculosis!

Pulmonary tuberculosis is the most common cause for cavitary lung disease in India. Radiological presentations in pulmonary tuberculosis are different and mainly depend on the immune status of hosts, durations of illness and underlying comorbidities. Consolidation, cavitation, pleural effusion, airways disease and lymphadenopathy are frequently reported in thoracic tuberculosis. In this case report, a 36-year male, presented with constitutional symptoms for 4 months duration with partial response to medical treatment received according to their knowledge and experience towards pneumonia, bronchial asthma and bronchitis. Radiological investigations documented inhomogeneous nodular infiltrates in the left upper zone which was underestimated due to presence of crepitations and wheeze. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax due to nodular opacities and persistent symptoms and documented black hole in the starry sky pattern’ which is first time described in medical literature. ‘Blackhole in starry sky pattern’ is described in the present case as a giant lung cavity mimicking black hole and a satellite nodule mimicking a starry sky pattern. Satellite nodules are defined as ill-defined to well demarcated nodular opacities with or without conglomeration around tuberculous consolidation or cavity. We have done induced sputum microbiological workup and documented acid-fast bacilli in sputum smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms with Satellite nodules with pericavitary consolidation presenting as ‘black hole in the starry sky pattern’ in HRCT thorax to have successful treatment outcome.

Coccidioidal Pulmonary Cavitation: A New Age

Coccidioides species are thermally dimorphic fungi found in geographically defined areas of the Western Hemisphere. The primary portal of entry is respiratory, with symptomatic pneumonic diseases as the most common presentation. Subsequent pulmonary complications as well as extrapulmonary metastatic infection may occur, either of which may be the presenting disease manifestation. Cavitary lung disease may be found incidentally or when investigating symptoms such as cough or hemoptysis. This study aims to explore the spectrum of coccidioidal cavities and the evaluation and management in a cohort of patients seen at Kern Medical over the last 12 years.

Cavitating Consolidation with Acute Febrile Respiratory Illness &amp; ‘Sister Cavities’ Without Typical Constitutional Symptoms in Pulmonary Tuberculosis: A Rare But Possible!

Community acquired pneumonia is the most common cause for lung parenchymal infiltrates in chest radiograph in scenarios with acute febrile respiratory illness. Tuberculosis in India accounts for the highest number of cases and deaths in the world. In spite of an efficient National tuberculosis control program for five decades, Tuberculosis is still the number one cause of death due to infectious agents in India and one third of total global deaths occurs in India due to this disease. Tuberculosis may present with consolidation, cavitation, coin lesion, parenchymal infiltrates and hilar mass like lesions. Acute febrile respiratory illness without typical constitutional symptoms is not frequently described in pulmonary tuberculosis. In this case report, a 69-year male, presented with acute febrile respiratory illness of short duration. He was having high grade fever, cough, shortness of breath &amp; haemoptysis of less than two weeks duration. His symptoms were progressive and empirically treated as lower respiratory tract infection or community acquired pneumonia with oral and intravenous antibiotics by general physicians and family physicians. Family physician referred to our center for worsened general health with increased shortness of breath with episodes of minimal haemoptysis. Chest x-ray documented right lower lobe consolidation which has progressed to central cavitations and thick pericavitary rim of consolidation mimicking lung abscess. Clinically he was having crepitations in the right inframammary and infrascapular area with egophony heard. HRCT thorax showed consolidation with cavitation in the superior segment of the right lower lobe and adjacent small cavity in the posterior segment presenting as a ‘Sister cavity’ accompanying a large parent cavity. He was unable to produce sputum and we have processed induced sputum examination which has documented acid-fast bacilli in smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Initially, microbiologists refused for smear preparation due to salivary nature and poor-quality sputum. We have insisted for microbiology workup due to high chances of yield due to cavitary lung disease and noted positive yield. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. Acute febrile respiratory illness and absence of typical constitutional symptoms is not uncommon. Although cavitating consolidation is commonly described in community acquired pneumonia, presence of ‘sister cavity’ is a radiological clue to think and proceed to workup towards active pulmonary tuberculosis. Induced sputum has a very significant impact on diagnostic yield. Pulmonary tuberculosis should be suspected early in cases with cavitating consolidations to have a successful treatment outcome.

Cavitating lung disease is not always due to tuberculosis! Wegener’s granulomatosis with mycetoma with deep vein thrombosis lower limb: Case report with review of literature

Pulmonary tuberculosis is most common cause for bilateral pulmonary cavities with constitutional symptoms in India being endemic and more prevalent nature of disease, irrespective of microscopy or nucleic acid amplification test abnormalities. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from nodule, consolidation, and cavitation. In this case report, 49-year female, presented with constitutional symptoms with lung parenchymal consolidations progressed to cavitation’s and started empirical anti-tuberculosis treatment without mycobacterial microscopic or genome documentation in sputum with clinical or radiological worsening. Bronchoscopy workup is inconclusive and tropical screen for bacterial, TB, and malignancy were negative and fungal yield aspergillus colonization. Vasculitis workup done in presence of clinical and radiological worsening documented PR3-ANCA positive with very highly raised titers. We have started on steroids, cyclophosphamide with antifungals and clinical response documented with near complete resolution of shadows in 24 weeks. She had developed DVT (deep vein thrombosis) lower limb during course of illness and documented excellent response to anticoagulation. DVT prophylaxis is must in all cases taking steroids with decreased daily activities to prevent fatal cardiovascular complications.

Beware of the master masquerader- A case series of cavitary lung disease with hearing loss.

Granulomatosis with polyangiitis (GPA) is an etiologically unknown systemic disease characterized by necrotizing granulomatous inflammation. Additionally, it is accompanied by vasculitis of small and medium-sized blood vessels. It manifests clinically as a triad involving the lungs, upper airways, and kidneys. It is estimated that 90% of patients will exhibit upper or lower airway symptoms and around 80% develops the renal disease. In this article, we describe three case scenarios with varying presentations. GPA should be considered among the possible etiologies of cavitary pulmonary lesions with ear manifestations including hearing loss with poor response to unusual treatment.

1421. A 5-year Review of Mycobacterium abscessus Susceptibility in a Tertiary Hospital in Thailand

Abstract Background Mycobacterium abscessus is a common rapid growing mycobacteria (RGM). It causes chronic nodular or cavitary lung disease in adults with bronchiectasis or cystic fibrosis, skin and soft tissue infection following penetrating injury or an unsterile skin procedure. It was also a pathogen of disseminated infection in patients with anti-interferon-gamma autoantibodies. The 2018 clinical and laboratory standards institute (CLSI) guideline suggested that amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, linezolid, meropenem, moxifloxacin, trimethoprim-sulfamethoxazole, tigecycline and tobramycin should be tested against RGM. We aimed to review the antimicrobial susceptibility of this organism in our hospital. Methods We performed a retrospective descriptive review of the minimal inhibitory concentration (MIC) of clinical isolates of M. abscessus from 2013 to 2018. Results We found 267 isolates of M. abscessus. Eighty-four isolates were tested for MICs. Of these, 4 isolates were excluded due to duplication. The remaining 80 isolates were included for analysis. The susceptibility results were as follows. Conclusion To our knowledge, this is the largest report of susceptibility pattern of M. abscessus in Thailand. MICs of cefoxitin and imipenem, which are the recommended intravenous antimicrobials, were high. Most isolates also demonstrated high MICs of doxycycline, linezolid, trimethoprim-sulfamethoxazole, tobramycin, ciprofloxacin and moxifloxacin. In contrast, most of MICs of amikacin and clarithromycin were in susceptible range. These findings may be used to guide the treatment regimen although clinical outcomes of each drug are still to be investigated. Disclosures All Authors: No reported disclosures.

Abstract 11104: Percutaneous Embolization of Extensive Collateral Vessels for Hemoptysis in Pulmonary Aspergilloma

Introduction: Pulmonary aspergillomas form due to fungal colonization in patients with immunocompromise and underlying cavitary lung disease. They can present with hemoptysis due to erosion of pulmonary vessels and formation of collaterals. Arterial embolization of bronchial vessels is considered first line treatment due to effectiveness and minimal invasiveness. We present one patient with need for extensive embolization treatment for persistent hemoptysis. Case: 53yo woman with pulmonary sarcoidosis and bilateral pulmonary aspergilloma presented to our institution for lung transplant evaluation. She had persistent hemoptysis for years after being diagnosed. She previously had bronchial artery embolization at outside hospital but had persistent symptoms severely limiting her functional status. She continued to have active hemoptysis during the admission, including on arrival to procedure. Angiography demonstrated extensive collateral vessels from systemic arterial to pulmonary circulation including several large branches originating from the subclavian arteries, internal mammary arteries and dorsal scapular arteries. There was leak through multiple previously embolized arteries, with active extravasation of contrast. Initial large collaterals were embolized using Medtronic MVP micro-vascular plugs (3Q, 5Q, 7Q) and smaller collaterals from intercostal arteries embolized using Penumbra Ruby Coil. She had improvement following the first procedure, but had persistent hemoptysis requiring repeat procedures to address more collateral and native vessels prior to resolution of symptoms. Conclusions: This patient with bilateral pulmonary aspergilloma had previous unsuccessful coil embolizations and complex collateral vessel system that resulted in severe recurrent bleeds. We successfully treated this patient’s persistent massive hemoptysis after extensive embolizations during multiple challenging procedures.

SUCCESSFUL BIOPSY OF AORTOPULMONARY WINDOW LYMPH NODE WITH ROBOTIC-ASSISTED BRONCHOSCOPY

SUCCESSFUL BIOPSY OF AORTOPULMONARY WINDOW LYMPH NODE WITH ROBOTIC-ASSISTED BRONCHOSCOPY

SINGLE CAVITARY LUNG LESION IN A HEALTHY YOUNG MALE

SINGLE CAVITARY LUNG LESION IN A HEALTHY YOUNG MALE

MULTIPLE CAVITATORY LUNG LESIONS DUE TO GROUP B STREPTOCOCCUS IN A HEALTHY ADULT

MULTIPLE CAVITATORY LUNG LESIONS DUE TO GROUP B STREPTOCOCCUS IN A HEALTHY ADULT

P145 Co-infections due to Aspergillus and Mucorales: Case series from a superspecialty medical center in India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo present details of a case series of fungal co-infection (aspergillosis and mucormycosis) including clinical course, laboratory diagnosis, treatment, and outcome.MethodsClinical histories of 7 cases of fungal co-infection (3 pulmonary, 4 rhino-orbito-cerebral or sino-nasal) were collected by chart review, and reports of samples sent to the mycology laboratory for direct microscopy and fungal culture were retrieved from laboratory records. Presence of septate and aseptate hyphae in direct microscopy of clinical samples and/or growth of Aspergillus spp and Mucorales in culture was considered as evidence of probable co-infection with mucormycosis and aspergillosis (as per EORTC guidelines).ResultsMechanical ventilation, cavitary lung disease, and renal failure with metabolic acidosis were unique risk factors observed for pulmonary co-infection, while use of systemic corticosteroids for treatment of SARS-CoV-2 infection was common in rhino-orbito-cerebral (ROC) or sino-nasal (SN) co-infection. Diabetes mellitus was a common risk factor for both groups of cases.Fever, cough, chest pain, and shortness of breath were the most common features in pulmonary fungal co-infection cases, while headache, facial swelling and pain, nasal stuffiness, decreased vision, and altered sensorium were the most common features in ROC/SN co-infection.Consolidation or collapse, bronciectasis, cavitatory changes in and nodules were the most frequent radiological features in pulmonary fungal co-infection cases, while mucosal thickening in multiple paranasal sinuses, and involvement of orbit and cavernous sinuses were the most frequent features in ROC or SN co-infection.Presence of aseptate and septate hyphae in direct microscopy was seen in tissue samples from all ROC/SN cases, which enabled early intervention. However direct microscopy was not indicative of co-infection in any of sputum samples from pulmonary cases, and diagnosis was only established by culture, leading to delayed initiation of treatment or no treatment. Liposomal amphotericin B (lAMB) ranging from 50-200 mg/day was used for treatment of fungal co-infection, with posaconazole 600-800 mg/day as step-down therapy or if lAMB was not tolerated.Out of three pulmonary fungal co-infection cases, only one received appropriate antifungal treatment but expired nonetheless. Out of the two untreated patients, one expired, and one was discharged against medical advice without resolution of symptoms. Surgical intervention was not done for any patient. In comparison, 3 out of 4 cases of ROC/SN co-infection were appropriately managed with immediate surgical debridement and survived. The remaining patient received appropriate antifungals but refused surgical intervention and expired.ConclusionsFungal co-infection with aspergillosis and mucormycosis is a serious condition requiring early intervention. This is facilitated by high sensitivity of direct microscopy in tissue samples used for diagnosis in ROC/SN co-infection, but hindered by low sensitivity of direct microscopy in sputum/BAL samples used for diagnosis in pulmonary cases rather than lung biopsy. Robust clinical advisory services, early diagnosis, and combined surgical and pharmacological approaches are crucial to a favorable outcome.

Wegener's granulomatosis mimicking like pulmonary tuberculosis and presenting as cavitating lung disease with mycetoma

Pulmonary tuberculosis (TB) is the most common cause of bilateral pulmonary cavities with constitutional symptoms in India being endemic and more prevalent nature of the disease, irrespective of microscopy or nucleic acid amplification test abnormalities. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from nodule, consolidation, and cavitation. In this case report, a 45-year-old female, presented with constitutional symptoms with lung parenchymal consolidations progressed to cavitation, and started empirical anti-TB treatment without mycobacterial microscopic or genome documentation in sputum with clinical or radiological worsening. Bronchoscopy workup is inconclusive and the tropical screen for bacterial, TB, and malignancy was negative and fungal yield Aspergillus colonization. A vasculitis workup was done in the presence of clinical and radiological worsening documented PR3-antineutrophil cytoplasmic antibody positive with very highly raised titers. We have started on steroids and cyclophosphamide with antifungals and clinical response was documented with a near-complete resolution of shadows in 24 weeks.

Diagnostic Yield of Bronchoscopic Alveolar Lavage Gene Xpert MTB/Rif in Smear Negative Clinico-Radiologically Suspected Case of Pulmonary Tuberculosis

Background: Early diagnosis of pulmonary tuberculosis is difficult but dreaded complications like cavitations, abscess, disseminations and fibrosis of lung parenchyma can be avoided. Sputum microscopy is still the most available test for diagnosis of pulmonary tuberculosis but sustainable number of active cases remains undiagnosed via this method alone. In strong clinico-radiological pulmonary tuberculosis patients who are sputum scarce or sputum microscopy and sputum Xpert MTB/Rif negative broncho-alveolar lavage may provide superior sample for Gene Xpert MTB/Rif in diagnosis of Pulmonary Tuberculosis.&#x0D; Materials and Methods: Over 2 years period, patients with strong clinico-radiological suspicion of pulmonary tuberculosis who had sputum microscopy and sputum Xpert MTB/Rif negative were included in the study. Fibro-optic bronchoscopy was done for BAL Xpert MTB/Rif test. Base line demographic, clinical and radiological data were systematically analysedby SPSS software version 17.&#x0D; Results: 64 patients were included in the study with mean age 41 ± 10.52 years. The most common symptoms were cough, sputum production and weight loss with frequency of 58 (90.6%), 31 (48.4%) and 21 (32.11%) patients respectively. The most common CT scan findings were consolidation, cavitation and tree in bud pattern. BAL Xpert MTB/Rif was positive in 11 (17.18%) patients. According to the CT findings BAL Xpert MTB/Rif was most commonly present in patients presenting with cavitary lung disease.&#x0D; Conclusion: Eleven patients had BAL gene Xpert/Rif positive out of 64 patients who were sputum scarce or had both microscopy and sputum gene Xpert/Rif negative. Bronchoscopy BAL Xpert/Rif could provide an additional diagnostic test in these groups of patients.

Cavitary lung disease in hospitalized patients: Differences between melioidosis and tuberculosis.

To differentiate cavitary lung lesions caused by melioidosis and tuberculosis is challenging, especially in endemic countries. A study with a matched-sampling method (16 cavitary pulmonary melioidosis vs. 16 cavitary pulmonary tuberculosis) showed characteristics of bacterial infection more obvious and severe in the melioidosis patients, which were useful to distinguish two conditions.

Clinical presentations of nontuberculous mycobacteria as suspected and drug-resistant tuberculosis: Experience from a tertiary care center in Eastern India.

Nontuberculous mycobacteria (NTM) are on the rise worldwide. The diagnosis and treatment of NTM disease create a dilemma for physicians as their clinical features often overlap with that of tuberculosis (TB). The present study aims to report a series of NTM infections presenting as suspected TB. It was a prospective observational study starting from December 2018 to January 2022. A total of 1850 suspected TB patients (pulmonary = 522 and extrapulmonary = 1328) were included in this study. Clinical features, radiological findings, microbiological diagnosis, treatment, and outcome were recorded. Clinical specimens were processed for Ziehl-Neelsen staining, GeneXpert MTB/Rif assay by cartridge-based nucleic acid amplification test, and culture. The culture-positive isolates were categorized as Mycobacterium tuberculosis complex or NTM depending on the detection of MPT64 antigen by immunochromatographic test. The NTM isolates were speciated by line probe assay using GenoType® Mycobacterium common mycobacteria kit. The criteria of the American Thoracic Society/Infectious Diseases Society of America were applied to confirm NTM disease. Of 1850 suspected TB patients, NTM disease was diagnosed in 20 patients (pulmonary = 9, nonpulmonary = 11). Eight NTM cases presented as suspected drug-resistant-TB with a history of antitubercular therapy. Among pulmonary NTM cases, Mycobacterium scrofulaceum (n = 7) was the most common species followed by Mycobacterium kansasii (n = 1) and Mycobacterium intracellulare (n = 1). In nonpulmonary cases, Mycobacterium abscessus (n = 8) was involved in majority of cases followed by Mycobacterium fortuitum (n = 3). Cavitary lung disease and laparoscopic port site infections were most frequent pulmonary and non-pulmonary manifestations respectively. Hence, there is an urgent need for better diagnostic and drug susceptibility testing facility along with standardized treatment protocol for NTM disease.