AP-HP, Service de maladies infectieuses et tropicales, CHU Bicêtre, Le Kremlin-Bicêtre, France.
Département d'hématologie, Gustave Roussy, Villejuif, France.
Transpl Infect Dis. 2021 Aug;23(4):e13594. doi: 10.1111/tid.13594. Epub 2021 Mar 11.
Disseminated nocardiosis is a rare but growing concern in immunocompromised patients. Typical localizations include the lung, brain and/or soft tissues, but laboratory confirmation of nocardiosis usually requires sampling of infected organs by invasive procedures such as bronchoalveolar lavage or brain biopsy. We report a case of disseminated nocardiosis occurring in a hematopoietic stem-cell transplant recipient, with clinical lung and brain localizations. Examination of the thyroid gland was suggestive of a unilateral abscess. A culture of thyroid pus sampled by fine-needle aspiration was positive for Nocardia farcinica and therefore avoided a more invasive procedure. The patient recovered after a six-month antibiotic therapy without thyroid surgery. We reviewed other ten cases of thyroid nocardiosis published in the medical literature. Among the ten cases of disseminated nocardiosis established during the patient's lifetime including ours, six (60%) were asymptomatic and seven (70%) were confirmed by culture of the aspiration of thyroid pus. When disseminated nocardiosis is suspected, systematic examination for a thyroid abscess may help establish a microbiological diagnosis and prevent further invasive procedures.
播散性奴卡菌病是免疫功能低下患者中一种罕见但日益受到关注的疾病。典型的感染部位包括肺部、脑部和/或软组织，但奴卡菌病的实验室确诊通常需要通过支气管肺泡灌洗或脑活检等有创手段采集感染器官的样本。我们报告了一例造血干细胞移植受者发生的播散性奴卡菌病，临床表现为肺部和脑部感染。对甲状腺的检查提示单侧脓肿。经细针抽吸甲状腺脓液培养呈奴卡菌阳性，因此避免了更具侵袭性的操作。该患者在接受六个月的抗生素治疗后痊愈，无需进行甲状腺手术。我们复习了医学文献中报道的其他 10 例甲状腺奴卡菌病病例。在包括我们的病例在内的 10 例确诊为播散性奴卡菌病的患者中，有 6 例（60%）无症状，7 例（70%）通过抽吸甲状腺脓液培养得到确诊。当怀疑发生播散性奴卡菌病时，对甲状腺脓肿进行系统检查有助于确立微生物学诊断，并避免进一步的有创操作。
