Hadano Yoshiro, Ohmagari Norio, Suzuki Jun, Kawamura Ichiro, Okinaka Keiji, Kurai Hanako, Tomioka Hiroyuki, Kinugasa Yusuke, Ohkusu Kiyofumi
Division of Infectious Diseases, Shizuoka Cancer Center Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Aug;49(8):592-6.
An 82-year-old woman with a past history of a colectomy for colon cancer was admitted to our hospital because of fever and cough. Her chest radiologic images on admission showed bilateral pulmonary infiltration, which suggested community-acquired pneumonia. However, the results of gram and acid-fast staining demonstrated branching acid-bacilli, which suggested pulmonary nocardiosis. We administered sulfamethoxazole-trimethoprim, and her condition and radiology findings promptly improved. Nocardia cyriacigeorgica was identified from her sputum. One of the nocardial isolates, formerly identified as Nocardia asteroides, has recently been reclassified as Nocardia cyriacigeorgica by the 16S rRNA gene amplification method. Pulmonary nocardiosis may be misidentified as "aspiration pneumonia", especially in elderly people. It is important for patients with community-acquired pneumonia to be evaluated with sputum gram staining for accurate diagnosis.
一名82岁女性，既往因结肠癌行结肠切除术，因发热和咳嗽入住我院。入院时胸部影像学检查显示双侧肺部浸润，提示社区获得性肺炎。然而，革兰氏染色和抗酸染色结果显示为分支杆菌，提示肺诺卡菌病。我们给予复方磺胺甲恶唑治疗，她的病情和影像学表现迅速改善。从她的痰液中鉴定出乔治西里亚星诺卡菌。其中一株曾被鉴定为星形诺卡菌的诺卡菌分离株，最近通过16S rRNA基因扩增方法重新分类为乔治西里亚星诺卡菌。肺诺卡菌病可能被误诊为“吸入性肺炎”，尤其是在老年人中。对于社区获得性肺炎患者，通过痰液革兰氏染色进行评估以准确诊断非常重要。
