Suemori Koichiro, Miyamoto Hitoshi, Murakami Shinobu, Yamazaki Hitoshi, Ishizaki Jun, Matsumoto Takuya, Murakami Yuichi, Hasegawa Hitoshi, Yasukawa Masaki
Kansenshogaku Zasshi. 2015 Jul;89(4):470-5. doi: 10.11150/kansenshogakuzasshi.89.470.
Nocardia asiatica is a rare causative organism responsible for opportunistic infection, and was first reported by Kageyama et al. in 2004. We report herein on a very rare case of N. asiatica infection in a 76-year old male patient with ANCA-associated vasculitis and a history of pulmonary tuberculosis. The patient developed pulmonary nocardiosis due to N. asiatica while receiving glucocorticoid therapy. Chest computed tomography demonstrated multiple granules and cavity formation mainly in the left lower lobe. From the images, we suspected opportunistic infection, possibly pulmonary tuberculosis or pulmonary damage due to ANCA-associated vasculitis. Nocardia sp. was detected from a bronchoalveolar lavage culture and N. asiatica was identified by 16S ribosomal DNA gene sequencing. Cranial magnetic resonance imaging revealed no abnormality. Administration of Doripenem (1.5g/day) and sulfamethoxazole-trimethoprim (4g/day) was started, and the patient's clinical and imaging findings promptly improved. Thereafter, he received sulfamethoxazole-trimethoprim (2g/day) and prednisolone (10 mg/day) as maintenance therapy for ANCA-associated vasculitis for more than one year, and there has since been no recurrence of the Nocardia infection.
亚洲诺卡菌是一种罕见的引起机会性感染的病原体，于2004年由Kageyama等人首次报道。我们在此报告一例非常罕见的亚洲诺卡菌感染病例，患者为一名76岁男性，患有抗中性粒细胞胞浆抗体（ANCA）相关血管炎并有肺结核病史。该患者在接受糖皮质激素治疗期间发生了由亚洲诺卡菌引起的肺诺卡菌病。胸部计算机断层扫描显示多个结节及空洞形成，主要位于左肺下叶。从影像来看，我们怀疑是机会性感染，可能是肺结核或ANCA相关血管炎所致的肺部损害。在支气管肺泡灌洗培养中检测到诺卡菌属，并通过16S核糖体DNA基因测序鉴定为亚洲诺卡菌。头颅磁共振成像未显示异常。开始给予多黏菌素B（1.5克/天）和复方磺胺甲恶唑（4克/天）治疗，患者的临床和影像表现迅速改善。此后，他接受复方磺胺甲恶唑（2克/天）和泼尼松龙（10毫克/天）作为ANCA相关血管炎的维持治疗，持续一年多，此后诺卡菌感染未再复发。
