Pulmonary Nocardiosis Caused by &lt;i&gt;Nocardia exalbida&lt;/i&gt; in a Patient with Lung Cancer and Radiation Pneumonitis: A Case Report and Literature Review

Kato, Kaori; Noguchi, Shingo; Naito, Keisuke; Ikushima, Issei; Hanaka, Tetsuya; Yamasaki, Kei; Kawanami, Toshinori; Yatera, Kazuhiro

doi:10.2169/internalmedicine.2177-18

Cited by 11 publications

(5 citation statements)

References 31 publications

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“…Only 3 out of 7 patients had fever, so fever is not always present in nocardiosis patients. Multisite abscesses includes subcutaneous, pulmonary and cerebral abscesses [ 42 , 43 ], which are commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors. Considering that direct extrinsic contact and inhalation are the main routes of Nocardia infection, subcutaneous and lung tissues are the most frequently affected sites of nocardiosis [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

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Section: Discussionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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“…A search tool algorithm for basic local comparisons was used to perform a homology search (15). This is generally considered the gold standard for bacterial identification (16,17). However, rRNA gene sequencing fails to discriminate between some species of Nocardia, likely because DNA-DNA hybridization studies have shown there is high sequence similarity between Nocardia species (18).…”

Section: Discussionmentioning

confidence: 99%

Mild Pulmonary Nocardiosis Caused by <i>Nocardia terpenica</i> in an Immunocompetent Patient

Dong

Guan

et al. 2023

Intern. Med.

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A 53-year-old immunocompetent man was admitted to our hospital because of paroxysmal cough with a low fever for more than 5 months. On admission, chest computed tomography showed multiple plaques and nodules, some with small central cavities, in both lungs and cystic and columnar bronchiectasis of the right middle bronchus. Treatment with various antibiotics was ineffective. Metagenomic next-generation sequencing of the bronchoalveolar lavage fluid showed Nocardia terpenica, and this organism was cultured from bronchoalveolar lavage fluid, resulting in a diagnosis of pulmonary nocardiosis. After administration of trimethoprim-sulfamethoxazole for 5 weeks, chest computed tomography showed a significant reduction in the lung lesions that had been detected on admission. Immunosuppressed patients are particularly prone to nocardiosis infection, which is usually severe. N. terpenica has rarely been detected in clinical samples, and its characteristics require further study with the accumulation of more clinical cases.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Nocardiosis is known as an opportunistic infection in immunocompromised hosts, but it occasionally has been reported in immunocompetent patient. The Nocardia exalbida is first-reported in 2006 from Japan, and a few cases of have been reported in only immunocompromised host, and the characteristic is still unclear. We herein describe the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. Case presentation A77 -year-old Japanese man was admitted to our hospital on November 2, 2018. He was a lifelong non-smoker with no childhood history of respiratory disease. He had a medical history of dyslipidemia. One month before this admission fevers, sputum, mild cough were developed and he was evaluated in a clinic near our hospital. His diagnosis was community acquired pneumonia within his right middle lobe. He was treated with ceftriaxone 1 g/day intravenously for a week, however his symptoms relapsed a few days later. So, the physician retried ceftriaxone for another 3 days, but his symptoms did not improve. He was referred to our hospital. He was treated with sitafloxacin as an outpatient for a week, however his symptoms got worse. The chest CT showed consolidation and atelectasis in his right middle lobe. Low density area was scattered in consolidation, and right pleural effusion was observed. The patient was diagnosed with pulmonary abscess and he was admitted. Administration of piperacillin/tazobactam improved his condition. We switched antibiotics to amoxicillin/clavulanate, and he was discharged. After 2 weeks, he relapsed and was admitted again. After administration of piperacillin/tazobactam for 3 weeks, we perform bronchoscopy and Nocardia species were cultured from samples of the bronchial wash. The isolates were identified as N. exalbida using 16S rRNA gene sequencing. We prescribed Trimethoprim / Sulfamethoxazole (TMP/SMX) for 4 months. Then we switched to minocycline for renal dysfunction caused from TMP-SMX for 1 more month. After 5 months therapy, Consolidation on CT disappeared, and Nocardiosis was cured. Conclusion we reported the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. N. exalbida infection might be associated with a good response to treatment.

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Pulmonary Nocardiosis Caused by <i>Nocardia exalbida</i> in a Patient with Lung Cancer and Radiation Pneumonitis: A Case Report and Literature Review

Cited by 11 publications

References 31 publications

Nocardiosis in glomerular disease patients with immunosuppressive therapy

Nocardiosis in glomerular disease patients with immunosuppressive therapy

Mild Pulmonary Nocardiosis Caused by <i>Nocardia terpenica</i> in an Immunocompetent Patient

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

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