Pulmonary nocardiosis presenting as bilateral pneumonia in an immunocompetent patient – An unusual host response

Shailesh Kumar, R. Pajanivel, N. Joseph, S. Umadevi, M. Hanifah, R. Singh
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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.
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肺诺卡病表现为双侧肺炎在免疫功能正常的病人-一个不寻常的宿主反应
肺诺卡菌病(PN)是由诺卡菌引起的一种罕见而严重的感染,它可以作为机会性病原体和原发病原体。诺卡菌感染的表现是多变的。我们报告一例肺诺卡病在免疫能力的24岁女性,谁最初治疗美罗培南没有反应。胸片示双侧不规则结节(空化),模糊区域,支气管血管标记突出,轻度积液。从胸膜液中分离出诺卡菌。胸膜活检显示肉芽肿病变伴分枝丝状杆菌。甲氧苄氨嘧啶-磺胺甲恶唑联合美罗培南治疗后病情好转。我们的报告强调,对于没有危险因素的患者,需要高度的临床怀疑。在肺炎患者中,如果肺部感染对社区获得性肺炎的抗菌治疗反应不佳,则应考虑肺诺卡菌病,并有必要仔细寻找该有机体的证据。此外,我们的病例强调,虽然肺诺卡菌病通常是化脓性的,但很少会发生肉芽肿反应。
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