Case report from a pediatric multidrug-resistant tuberculosis case with Tsukamurella co-infection identified by whole-genome sequencing: a diagnostic and therapeutic challenge.

BACKGROUND: Tsukamurella species are rarely reported pathogens that can clinically mimic tuberculosis (TB). We report a challenging case of Tsukamurella species co-occurring with multidrug-resistant tuberculosis (MDR-TB) in a pediatric patient.

CASE PRESENTATION: A 12-year-old HIV-negative female with a previous history of tuberculosis was admitted in August 2021 to Selale University Comprehensive Specialized Hospital in Ethiopia. She was diagnosed with MDR-TB and started on an all-oral bedaquiline-containing regimen. Whole genome sequencing later identified co-infection with Mycobacterium tuberculosis Lineage 3 (Central Asian Strain) and Tsukamurella spp.

CONCLUSION: This case highlights the critical importance of considering Tsukamurella sp. co-infection in patients with culture-positive MDR-TB who exhibit an atypical or persistent clinical course. The diagnostic mimicry between these pathogens necessitates the use of advanced microbiological techniques for accurate identification, as standard TB workflows may overlook such rare co-infections.