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Not everything acid fast is Mycobacterium tuberculosis--a case report.
  1. E S Olson,
  2. A J Simpson,
  3. A J Norton,
  4. S S Das
  1. Department of Medical Microbiology, St Bartholomew's Hospital, London, UK.

    Abstract

    The Ziehl-Neelsen (ZN) stain is important in identifying organisms that are acid fast, principally Mycobacterium tuberculosis. However, decolorisation with a weaker acid concentration (for example 1% hydrochloric acid), often used in ZN staining in histology, can result in a wider variety of organisms appearing acid fast and can be a cause of misidentification. To illustrate this point, a patient is described with pulmonary nocardiosis who was misdiagnosed as having tuberculous empyema on pleural biopsy.

    https://doi.org/10.1136/jcp.51.7.535

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