Hirayama Tatsuro, Takazono Takahiro, Horai Yoshiro, Tashiro Masato, Saijo Tomomi, Kosai Kosuke, Morinaga Yoshitomo, Kurihara Shintaro, Nakamura Shigeki, Imamura Yoshifumi, Miyazaki Taiga, Tsukamoto Misuzu, Izumikawa Koichi, Yanagihara Katsunori, Kawakami Atsushi, Kohno Shigeru
Second Department of Internal Medicine, Nagasaki University Hospital, Japan.
Intern Med. 2016;55(9):1213-7. doi: 10.2169/internalmedicine.55.6228. Epub 2016 May 1.
A 68-year-old man was admitted to our hospital with anorexia and leg pain. He was diagnosed with ANCA-associated vasculitis through a renal biopsy. Immunosuppression with two courses of steroid pulse therapies and intravenous cyclophosphamide followed by oral prednisolone at 40 mg/day were administered. About one month after starting the immunosuppression therapy, he complained of hemosputum. Chest computed tomography showed a cavitary lesion in the lung. Cultures from his sputum showed Nocardia species, and we were able to identify the species as N. concava using a 16S rRNA gene sequence analysis. Only three detailed reports of N. concava infection have so far been published worldwide.
一名68岁男性因厌食和腿痛入院。通过肾活检诊断为抗中性粒细胞胞浆抗体相关性血管炎。给予两疗程的类固醇脉冲疗法和静脉注射环磷酰胺进行免疫抑制，随后口服泼尼松龙，剂量为每日40毫克。开始免疫抑制治疗约一个月后，他出现咯血。胸部计算机断层扫描显示肺部有空洞性病变。痰培养显示为诺卡菌属，通过16S rRNA基因序列分析，我们能够将该菌种鉴定为凹面诺卡菌。迄今为止，全世界仅发表了三篇关于凹面诺卡菌感染的详细报告。
