Pulmonary Nocardiosis in a Non-Hodgkin's Lymphoma Patient

Abstract

Nocardiosis is an opportunistic infection especially in immunocompromised patients. Lungs are the most common infection sites and therapy poses some difficulties. We describe a case of pulmonary infection with Nocardia asteroides in a non-Hodgkin's lymphoma patient. Although the mortality from pulmonary nocardiosis is high in immunocompromised patients, our patient was successfully treated with trimethoprim-sulfamethoxazole (TMP/SMZ) and amikacin. Maintenance therapy with TMP/SMZ was continued for 1 year. This case supports the importance of the long-term maintenance treatment after the initial combination therapy.

A cavitary lesion in the lung crossing the fissure

“…[2] To have an established nocardia infection, suppression of the cellular immunity is required. [3] It mimics pulmonary tuberculosis clinically and radiologically. [4] Nocardia asteroides is responsible for about 80% of invasive disease.…”

Pulmonary nocardiosis in a HIV infected patient

“…[8] Unlike pulmonary or disseminated nocardiosis, pulmonary cutaneous nocardiosis is usually seen in immunocompetent hosts. [2,[6][7][8][10][11][12][13][14] Primary cutaneous infection usually presents as lymphocutaneous infection, superficial cellulitis, or a localized abscess, and usually involves the face in children or the lower extremities in adults. Mycetoma is a late stage infection and is characterized by a chronic, localized, slowly progressive, often painless, subcutaneous and bone disease usually involving the foot.…”

“…[4] Pulmonary nocardiosis usually occurs in immunocompromised patients such as those suffering from lymphoreticular malignancies, Cushing's disease, organ transplant recipients, persons receiving high-dose steroids, chronic alcoholism, diabetes mellitus, and AIDS. [6,7] Menendez et al [10] reported 10 cases of pulmonary nocardiosis from Spain. Chronic obstructive pulmonary disease (COPD), neoplastic disease, and HIV infection were the underlying predisposing factors.…”

“…[1] Human infection is rare and contracted through inhalation. [2] Infection is more common in immunocompromised hosts, [1][2][3][4][5][6][7] specially with impaired cell-mediated immunity. It has been reported in patients with HIV infection.…”

Pulmonary Nocardiosis Misdiagnosed as Tuberculosis

“…About 8.5% of cases occur annually in U.S. are either systemic or pulmonary. The risk is increased in immune-suppressed patients especially those having lymphoma, AIDS and organ transplant [3].…”