Corticosteroids in the Treatment of Severe Nocardia Pneumonia in Chronic Granulomatous Disease

Abstract

Nocardia is one of five main pathogens that infect chronic granulomatous disease (CGD) patients. Despite aggressive antimicrobial therapy, medical treatment is not always successful and surgical resection of infected tissue has been intermittently required. We present two CGD patients with severe Nocardia pneumonia whose pulmonary status worsened despite appropriate antimicrobials, but then improved clinically and radiographically with the addition of corticosteroids.

Intravenous Immunoglobulin Treatment for Macrophage Activation Syndrome Complicating Chronic Granulomatous Disease

“…However, corticosteroids have also been used in addition to antimicrobials to treat refractory infections in CGD, and they are able to suppress inflammation in MAS [22,23]. It is important to note that microbiologic diagnosis is essential to rule out antibiotic failure [23]. This aspect is important because corticosteroids and immunosuppressants can exacerbate infection if the patient is without optimal antimicrobial coverage [22,23].…”

“…It is important to note that microbiologic diagnosis is essential to rule out antibiotic failure [23]. This aspect is important because corticosteroids and immunosuppressants can exacerbate infection if the patient is without optimal antimicrobial coverage [22,23]. On the other hand, experts suggest that there has to be a balance between halting progressing microbial infection and controlling damaging inflammation in CGD [20].…”

“…Corticosteroids typically have been used in gastrointestinal and obstructive complications. However, corticosteroids have also been used in addition to antimicrobials to treat refractory infections in CGD, and they are able to suppress inflammation in MAS [22,23]. It is important to note that microbiologic diagnosis is essential to rule out antibiotic failure [23].…”

Blood culture positive Nocardia asteroides infection: a case report

“…Nocardiosis, however, requires long term treatment. Sometimes, surgical intervention or even unusual measures such as additional treatment with corticosteroids are necessary for management [12].…”

An adult case of X‐linked chronic granulomatous disease with skin ulcer on the nose and internal canthus

“…Studies of pneumonitis and liver abscess in CGD patients suggested the effectiveness of steroid in conjunction with appropriate antimicrobials to alleviate the excessive inflammation related to infections. 1,5,6 In a retrospective study of adult CGD with pulmonary manifestations, 40% of the cases included inflammatory events induced after the infection, which were most often treated with immunomodulative therapies. 7 In our patient, topical steroid used in conjunction with systemic antibiotics treatment greatly contributed to improving the CGD-associated skin ulcer, without major adverse events.…”