Rodriguez J L, Barrio J L, Pitchenik A E
Chest. 1986 Dec;90(6):912-4. doi: 10.1378/chest.90.6.912.
A patient with the acquired immunodeficiency syndrome (AIDS) presented with Pneumocystis carinii pneumonia and pulmonary nocardiosis. The nocardial lesions appeared small and localized on chest radiograph. On two separate occasions, nocardial organisms were absent in transbronchial lung biopsy specimens, but were identified in bronchoalveolar lavage fluid probably because the latter specimen sampled a larger area of lung. The patient was initially treated with trimethoprim-sulfamethoxazole (TMP/SMX) for both infections. When TMP/SMX was discontinued because of an adverse reaction, the nocardiosis promptly exacerbated but was then easily controlled with minocycline and amikacin followed by minocycline and cycloserine. Among patients with AIDS who have sulfamethoxazole hypersensitivity during treatment for nocardiosis, alternative drugs may be efficacious and may be particularly important in this setting because they have a lower incidence of toxicity.
一名获得性免疫缺陷综合征（艾滋病）患者出现卡氏肺孢子虫肺炎和肺诺卡菌病。胸部X线片显示诺卡菌病变较小且局限。在两次不同的情况下，经支气管肺活检标本中未发现诺卡菌，但在支气管肺泡灌洗 fluid中发现了诺卡菌，可能是因为后一种标本采集的肺组织面积更大。该患者最初因两种感染均接受甲氧苄啶-磺胺甲恶唑（TMP/SMX）治疗。当因不良反应停用TMP/SMX后，诺卡菌病迅速加重，但随后用米诺环素和阿米卡星治疗后得到轻松控制，随后用米诺环素和环丝氨酸治疗。在治疗诺卡菌病期间对磺胺甲恶唑过敏的艾滋病患者中，替代药物可能有效，在这种情况下可能尤为重要，因为它们的毒性发生率较低。
