Pulmonary infection due to Nocardia exalbida complicated with pneumococcal pneumonia

Abstract

Introduction: Nocardia exalbida is an uncommon Nocardia sp., first described in 2006. We report a case of pulmonary infection due to this organism, which became evident after treatment of antecedent pneumococcal pneumonia.Case presentation: A 68-year-old man was hospitalized because of pneumococcal pneumonia. Although his symptoms improved immediately after administration of antipneumococcal antibiotics, patchy opacity on the chest X-ray remained and pyrexia recurred. Administration of trimethoprim/sulfamethoxazole, given after seropositivity against human immunodeficiency virus type 1 was confirmed and Nocardia-like organisms were detected from the sputa, completely resolved his symptoms. The recovered organism was identified as N. exalbida by comparison of 16S rRNA gene sequences. Conclusion:To the best of our knowledge, only six other cases of N. exalbida infection have been described. Most of these cases were reported from Japan, suggesting that the organism is more prevalent in this country than in other areas. The present case also highlights that underlying nocardiosis should be considered when an immunocompromised patient with acute bacterial pneumonia demonstrates refractory respiratory manifestations, despite receiving appropriate treatments.

Case report: pulmonary nocardiosis caused by Nocardia exalbida in an immunocompetent patient

“…Only 6 cases of pulmonary nocardiosis were reported including our case [ 10 , 12 , 14 ], one each with brain abscess [ 11 ], keratitis [ 10 ], endophthalmitis [ 13 ], blebitis [ 15 ], and pemphigus vulgaris [ 9 ].…”

“…N. exalbida infection might be associated with a good response to treatment [ 16 ]. In one case that had pneumonia with N. exalbida with HIV the patient was treated with TMP/SMX six tablet (approximately 12 mg per kg of body weight) for the TMP component) monotherapy for 12 month and cure [ 14 ]. In our case we prescribed TMP/SMX 4 tablets (approximately 5 mg per kg of body weight) for the TMP component) monotherapy for 4 months and switched to minocycline for 1 month because renal injury induced by TMP/SMX had been suspected.…”