Kuroki S, Yamada H, Katoh O, Nakanishi Y, Yamaguchi M, Nagasawa Z
Saga Medical School.
Kansenshogaku Zasshi. 1990 Feb;64(2):243-8. doi: 10.11150/kansenshogakuzasshi1970.64.243.
Pulmonary nocardiosis is a rare disease. We reported a case of pulmonary nocardiosis associated with middle lobe atelectasis. A 66-year-old female was admitted to Saga Medical School Hospital with complaints of fever, productive cough and hemosputum. Nocardia asteroides was isolated from her sputum and bronchial lavage fluid. Administration of sulfamethoxazole-trimethoprim (ST) improved her symptoms and Nocardia asteroides were rapidly eliminated from her sputum. However, she had severe side effects of ST: toxic dermatitis, granulocytopenia and liver dysfunction, whereupon administration of ST was stopped. About two weeks later, Nocardia asteroides appeared again in her sputum. Either netilmicin (NTL) or minocycline (MINO) given consecutively could not eliminate Nocardia asteroides from her sputa. Subsequently a combination therapy of OFLX administration and gentamicin inhalation was tried. This treatment improved her symptoms and eradicated Nocardia asteroides from her sputa completely. In vitro study, ST, MINO and aminoglycosides showed good susceptibility against Nocardia asteroides. In this case, it was revealed that GM inhalation therapy is also very useful for pulmonary Nocardiosis.
肺诺卡菌病是一种罕见疾病。我们报告了一例与中叶肺不张相关的肺诺卡菌病病例。一名66岁女性因发热、咳痰和咯血入住佐贺医科大学医院。从她的痰液和支气管灌洗液中分离出星形诺卡菌。给予磺胺甲恶唑-甲氧苄啶（ST）改善了她的症状，星形诺卡菌也迅速从她的痰液中清除。然而，她出现了ST的严重副作用：中毒性皮炎、粒细胞减少和肝功能障碍，于是停止了ST的给药。大约两周后，星形诺卡菌再次出现在她的痰液中。连续给予奈替米星（NTL）或米诺环素（MINO）都无法从她的痰液中清除星形诺卡菌。随后尝试了氧氟沙星给药和庆大霉素吸入的联合治疗。这种治疗改善了她的症状，并完全从她的痰液中根除了星形诺卡菌。体外研究表明，ST、MINO和氨基糖苷类药物对星形诺卡菌显示出良好的敏感性。在该病例中，发现庆大霉素吸入疗法对肺诺卡菌病也非常有效。
