Sukahri Samshol, Zainudin Lily Diana, Hadi Mohd Firdaus, Firdaus Mohd Al-Baqlish Mohd, Hafidz Muhammad Imran Abdul
General Medical Unit, Department of Medicine, University Technology MARA, Malaysia.
Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Case Rep Pulmonol. 2020 Oct 26;2020:8840920. doi: 10.1155/2020/8840920. eCollection 2020.
Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy.
肺诺卡菌病是一种罕见疾病，主要影响免疫功能低下的患者。我们报告一例37岁男性，表现为持续发热伴咳痰。在治疗过程中，他因胸腔积脓反复入院。临床上，他的生命体征正常。血液检查显示白细胞增多，红细胞沉降率（ESR）和C反应蛋白（CRP）显著升高。痰涂片抗酸杆菌（AFB）少量（1+），痰分枝杆菌培养阴性。胸部X线（CXR）显示右侧有实变改变伴轻至中度胸腔积液。进行了皮肤活检，显示为拟青霉属菌种。进行了胸部计算机断层扫描（CT），显示右半胸内有多个分隔的积液区，伴有胸膜分裂征。进行了胸膜剥脱术，组织培养及药敏（C+S）培养出该菌种。它对复方磺胺甲恶唑敏感，完成了4个月的治疗。该病例强调，在免疫功能正常的患者中也应考虑肺诺卡菌病，尤其是在疑似肺结核但对抗结核治疗无反应的病例中。
