A 65-year-old immunocompromised male presented with fever, abdominal pain, and elevated liver enzymes, leading to suspicion of infection. Initial investigations were inconclusive. A liver biopsy revealed granulomatous hepatitis, and subsequent metagenomic next-generation sequencing (mNGS) on the liver tissue identified Mycobacterium avium complex (MAC) as the causative agent. The patient was successfully treated with anti-mycobacterial therapy, showing clinical improvement. This case highlights the diagnostic utility of mNGS in identifying elusive pathogens in immunocompromised patients with atypical presentations, especially when conventional methods fail to yield a diagnosis.
Key note: mNGS can be crucial for diagnosing disseminated infections in immunocompromised patients.