Nocardiose pulmonar em paciente com síndrome da imunodeficiência adquirida: relato de caso

Abstract

Os autores descrevem um caso de nocardiose pulmonar em um homem de 37 anos de idade com a síndrome da imunodeficiência adquirida, em tratamento com anti-retrovirais, cujos sintomas de apresentação foram tosse com expectoração, hemoptóicos e emagrecimento progressivo. Foi realizada radiografia do tórax, que demonstrou consolidação no lobo superior do pulmão direito, e tomografia computadorizada do tórax, que evidenciou consolidação pulmonar com áreas escavadas. Diante dos achados radiológicos inespecíficos, foi realizada broncoscopia com lavado broncoalveolar, evidenciando estruturas filamentosas Gram-positivas compatíveis comNocardia sp. O tratamento utilizado foi sulfametoxazol-trimetoprim, com remissão completa do quadro respiratório. Após revisão da literatura, foram discutidos os principais aspectos radiológicos desta doença.

Nocardiose pulmonar em portador de doença pulmonar obstrutiva crônica e bronquiectasias

“…(6) Although the alterations observed on CT scans are similar to those of the conventional X-rays, CT is superior in demonstrating the exact location and extent of the lesions, as well as in the differentiation between pulmonary and pleural lesions. (5) In the case reported, the patient presented nodules of various sizes, disseminated throughout both lungs, and some of those nodules were cavitated.…”

“…The rest of the examination evidenced no alterations. Laboratory test results were as follows: 3,260,000 erythocytes/mm 3 ; hematocrit, 28%; hemoglobin, 9.6 g/dL; 11,130 leukocytes/mm 3 ; rods, 5%; segmented, 64%; eosinophils, 0%; lymphocytes, 10%; The pulmonary clinical profile can be acute, subacute or chronic in evolution, (3,5,9) and the principal symptoms are dyspnea, productive cough and fever. (2,8,9) In the case reported here, the patient presented a profile of dyspnea and fever, in addition to cough with purulent sputum, night sweats and severe prostration, with subsequent worsening of the dyspnea.…”

“…Nodules, cavitated masses, pleural effusion, pneumothorax, ground-glass opacities and interstitial patterns can occur as well. (1,4,5,11) Some studies show that, in HIV-infected patients, there is a higher percentage of cavitated lesions. (8) Alveolar consolidation in the upper lobes is often confused with pulmonary tuberculosis.…”

“…It can be difficult to confirm the diagnosis, and achieving such confirmation is dependent on the isolation of the microorganism in sputum samples, bronchoalveolar lavage fluid or culture. (2,5,6) Sputum cultures are positive in approximately 90% of patients, and positivity can be as high as 100% in bronchoalveolar lavage. (3) It is fundamental that the laboratory be informed of the suspicion of nocar-is found in 70% to 90% of the cases.…”

“…(1,3,5,7,8) Transmission occurs through inhalation and principally affects patients whose cellular immunity is compromised due to AIDS, neoplasia, transplantation or chronic use of corticosteroids, although there are reports of cases in previously healthy patients. (1,3,5,6,(9)(10)(11) In many studies in the literature correlating nocardiosis with corticosteroid therapy, it has been demonstrated that this correlation is more frequently observed in COPD than in any other disease. (1,3) Another disease in which this correlation is common is bronchiectasis.…”