Pulmonary Nocardiosis Developed in a Hematopoietic Stem Cell Transplant Recipient with Bronchiolitis Obliterans

Abstract

The chronic graft-versus-host disease often requires unceasing immunosuppressive therapy (IST), which increases a risk of infectious complications in hematopoietic stem cell transplantation (HSCT) recipients. We report an adult T-cell leukemia/lymphoma case who developed pulmonary nocardiosis, a rare pulmonary complication, after allogeneic HSCT despite administration of the prophylactic trimethoprimsulfamethoxazole (TMP/STX). The inhaled corticosteroid in addition to systemic IST had been started for bronchiolitis obliterance 4 months prior to nocardiosis development. The patient was successfully treated with an increased dose of TMP/STX combined with meropenem. Transplantation physicians should keep this rare pulmonary complication in mind during sustained IST.

Bacterial Pathogens Causing Pneumonia Post Hematopoietic Stem Cell Transplant: The Chronic GVHD Population

“…The majority of the cases reported were not receiving TMP-SMX for PJP prophylaxis but on inhaled pentamidine, atovaquone, and dapsone ( Table 4 ) [ 43 , 44 , 45 , 46 ]. Cases 3, 9, 13, 14, and 15 were on TMP-SMX [ 43 , 47 , 48 , 49 ]. Case 3 was on TMP-SMX prophylaxis, 80–400 mg; case 9 was on TMP-SMX, 80/400 mg; case 14 was on TMP-SMX, 20 mg/kg; and case 15 was on TMP-SMX, 160/800 mg [ 43 , 47 , 48 , 49 ].…”

“…Cases 3, 9, 13, 14, and 15 were on TMP-SMX [ 43 , 47 , 48 , 49 ]. Case 3 was on TMP-SMX prophylaxis, 80–400 mg; case 9 was on TMP-SMX, 80/400 mg; case 14 was on TMP-SMX, 20 mg/kg; and case 15 was on TMP-SMX, 160/800 mg [ 43 , 47 , 48 , 49 ].…”

Current treatment for nocardia infections

“…Meropenem has been used for Nocardia infections in addition to imipenem [60,61]. Susceptibility studies have shown activity against N. brasiliensis, N. asteroides and other Nocardia species [47].…”