Shailesh Kumar, R. Pajanivel, N. Joseph, S. Umadevi, M. Hanifah, R. Singh
{"title":"Pulmonary nocardiosis presenting as bilateral pneumonia in an immunocompetent patient – An unusual host response","authors":"Shailesh Kumar, R. Pajanivel, N. Joseph, S. Umadevi, M. Hanifah, R. Singh","doi":"10.5580/574","DOIUrl":null,"url":null,"abstract":"Pulmonary nocardiosis (PN) is an infrequent and severe infection due to Nocardia spp., which may behave as both opportunistic and primary pathogens. The presentation of a Nocardia infection is quite variable. We report a case of pulmonary nocardiosis in an immunocompetent 24-year-old female, who was initially treated with meropenem without response. A chest radiograph revealed bilateral irregular nodules (cavitating) with indistinct areas of haziness, prominent broncho-vascular markings and mild effusion. Nocardia spp. was isolated from pleural fluid. Pleural biopsy showed a granulomatous lesion with branching filamentous bacilli. She improved after trimethoprim-sulfamethoxazole was added along with meropenem. Our report emphasizes that a high level of clinical suspicion is required in patients without risk factors. In a patient with pneumonia if the lung infection responds poorly to antimicrobial therapy for community acquired pneumonia, pulmonary nocardiosis should be considered and a careful search for evidence of the organism is necessary. Furthermore our case emphasizes that although pulmonary nocardiosis is usually suppurative in nature, rarely a granulomatous response may occur.","PeriodicalId":22514,"journal":{"name":"The Internet journal of microbiology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Internet journal of microbiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5580/574","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
Abstract
Pulmonary nocardiosis (PN) is an infrequent and severe infection due to Nocardia spp., which may behave as both opportunistic and primary pathogens. The presentation of a Nocardia infection is quite variable. We report a case of pulmonary nocardiosis in an immunocompetent 24-year-old female, who was initially treated with meropenem without response. A chest radiograph revealed bilateral irregular nodules (cavitating) with indistinct areas of haziness, prominent broncho-vascular markings and mild effusion. Nocardia spp. was isolated from pleural fluid. Pleural biopsy showed a granulomatous lesion with branching filamentous bacilli. She improved after trimethoprim-sulfamethoxazole was added along with meropenem. Our report emphasizes that a high level of clinical suspicion is required in patients without risk factors. In a patient with pneumonia if the lung infection responds poorly to antimicrobial therapy for community acquired pneumonia, pulmonary nocardiosis should be considered and a careful search for evidence of the organism is necessary. Furthermore our case emphasizes that although pulmonary nocardiosis is usually suppurative in nature, rarely a granulomatous response may occur.