Tripathi Swapnil, Meena Durga Shankar, Rohila Amit Kumar, T R Neetha, Jain Vidhi, Kumar Deepak, Yadav Taruna, Garg Mahendra Kumar
Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, India.
BMC Infect Dis. 2021 Aug 3;21(1):745. doi: 10.1186/s12879-021-06452-6.
Empyema necessitans is a rare pulmonary condition described as the presence of pus in the pleural cavity with insidious extension into the surrounding soft tissue. The common microbial aetiology of empyema necessitans is tuberculosis. Nocardiosis a cause of empyema necessitans is rarely described in the literature. We herein present a case of an 80-year-old male with empyema necessitans with osteomyelitis of rib caused by Nocardia farcinica.
An 80-year-old male presented with complaints of soft swelling on the left lower posterior chest wall associated with dry cough and breathlessness on exertion. Computed Tomography (CT) thorax demonstrated empyema necessitans with features of left fifth rib osteomyelitis. Radiological guided aspiration of the chest wall collection revealed Nocardia species and surgical drainage of abscess was performed. Matrix-assisted laser desorption/ionization time-of-flight-mass spectrometry (MALDI-TOF-MS) identified the isolate as Nocardia farcinica. He was treated with three-drug regimen: Trimethoprim-sulfamethoxazole, amikacin and ceftriaxone for 2 weeks. After showing improvement patient was discharged and advised to take oral Trimethoprim-sulfamethoxazole for the next 6 months with periodic follow-up.
As our case demonstrates, the possibility of invasive Nocardiosis should not be overlooked even in immunocompetent patients. Clinicians should aware of this rare entity while treating patients with empyema necessitans.
坏死性脓胸是一种罕见的肺部疾病，表现为胸腔内有脓液并隐匿性蔓延至周围软组织。坏死性脓胸常见的微生物病因是结核病。文献中很少描述诺卡菌病作为坏死性脓胸的病因。我们在此报告一例80岁男性坏死性脓胸合并由鼻疽诺卡菌引起的肋骨骨髓炎病例。
一名80岁男性因左后下胸壁软组织肿胀、伴有干咳和活动时呼吸困难前来就诊。胸部计算机断层扫描（CT）显示为坏死性脓胸，伴有左第五肋骨骨髓炎的特征。经放射学引导对胸壁积液进行穿刺抽吸，发现诺卡菌属，并对脓肿进行了手术引流。基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF-MS）鉴定该分离株为鼻疽诺卡菌。患者接受了三联药物治疗：甲氧苄啶-磺胺甲恶唑、阿米卡星和头孢曲松，疗程为2周。病情好转后患者出院，并被建议在接下来的6个月内口服甲氧苄啶-磺胺甲恶唑，并定期随访。
正如我们的病例所示，即使在免疫功能正常的患者中，侵袭性诺卡菌病的可能性也不应被忽视。临床医生在治疗坏死性脓胸患者时应了解这种罕见疾病。
