Interstitial changes in the lungs could be caused by vast majority of diseases including tuberculosis, sarcoidosis, hypersensitive pneumonitis, metastatic injury of  the lungs, etc. Differential diagnosis of pulmonary dissemination remains an urgent  and challenging clinical task. This article is a review of published literature and  presentation of a clinical case of a patient with interstitial lung disease. The case  demonstrates diagnostic difficulties in identification the cause of interstitial lung  injuries. Interstitial lung injury was incidentally found in this patient and initially was  considered as disseminated pulmonary tuberculosis. In-depth diagnostic work-up  including lung tissue biopsy allowed diagnosis of lymphoid interstitial pneumonia associated with common variable immune deficiency. This case demonstrates  common misdiagnosis of pulmonary tuberculosis in a patient with interstitial lung injury.

Aim of the study. Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist. Materials and methods. A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer. Results and conclusion. As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.

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Aim: To identify the incidence and the characteristics of adverse reactions, to mitigate them, and to determine possible adjustments in antimicrobial therapy. Design: Observational retrospective long-term study. Materials and methods. We examined 125 patients with nontuberculous lung mycobacteriosis. 73.6% of cases had concomitant diseases. Results. The therapy for nontuberculous mycobacteriosis was prescribed in 115 patients, depending on drug susceptibility, and included at least 3 drug products. 31.3% of patients had adverse reactions; one third of these patients had allergic reactions. Hepatotoxic reactions were recorded in 16.5% of cases, cardiotoxic — in 12.2%, ototoxic — in 10.4%, optic neuritis was diagnosed in 5 % of cases. In 31.3% of cases, the therapy was adjusted, in 13.9% of cases, the therapy was reviewed and alternative treatment was offered. The complete antibacterial course was prescribed to 79 (68.7%) patients. Conclusion. The therapy for nontuberculous mycobacteriosis should be selected in inpatient settings with laboratory and functional monitoring. Keywords: nontuberculous lung mycobacteriosis, antimicrobial therapy, adverse reactions.