Sadamatsu Hironori, Takahashi Koichiro, Tashiro Hiroki, Komiya Kazutoshi, Nakamura Tomomi, Sueoka-Aragane Naoko
Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan.
Respirol Case Rep. 2017 Mar 26;5(3):e00229. doi: 10.1002/rcr2.229. eCollection 2017 May.
A 72-year-old Japanese woman was admitted at Saga University Hospital for fever, malaise, and productive cough. Six years ago, she had been diagnosed with bronchial asthma and was treated with inhaled corticosteroids. Chest radiograph and computed tomography on admission showed infiltrates in the right middle lobe, a mass lesion in the left lower lobe, and bronchiectasis in both lower lobes. Sputum examination showed Gram-positive rods with phagocytosis by neutrophils. These bacilli were identified as Nocardia otitidiscaviarum by 16S ribosomal RNA sequencing. Therefore, she was diagnosed with pulmonary nocardiosis and was treated with trimethoprim/sulfamethoxazole (TMP-SMX) and minocycline (MINO). However, she had to discontinue these antibiotics because of severe nausea and anorexia and instead was treated with fluoroquinolone for 6 months. There was resolution of the disease thereafter. Pulmonary nocardiosis with bronchial asthma and bronchiectasis can be successfully treated with fluoroquinolone, an alternative to TMP-SMX or MINO.
一名72岁的日本女性因发热、全身乏力和咳痰入住佐贺大学医院。六年前，她被诊断出患有支气管哮喘，并接受吸入性糖皮质激素治疗。入院时的胸部X光片和计算机断层扫描显示右中叶有浸润影，左下腹有肿块，双下叶有支气管扩张。痰液检查显示革兰氏阳性杆菌被中性粒细胞吞噬。通过16S核糖体RNA测序，这些杆菌被鉴定为耳氏诺卡菌。因此，她被诊断为肺诺卡氏菌病，并接受了甲氧苄啶/磺胺甲恶唑（TMP-SMX）和米诺环素（MINO）治疗。然而，由于严重的恶心和厌食，她不得不停用这些抗生素，转而接受氟喹诺酮治疗6个月。此后病情得到缓解。对于合并支气管哮喘和支气管扩张的肺诺卡氏菌病，氟喹诺酮可作为TMP-SMX或MINO的替代药物成功进行治疗。
