Ishikawa Kazuhiro, Mori Nobuyoshi
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
IDCases. 2022 Jun 22;29:e01545. doi: 10.1016/j.idcr.2022.e01545. eCollection 2022.
An 84-year-old female with severe liver cirrhosis due to hepatitis C presented with a progressive bulging of the anterior chest wall for two weeks. On examination, 7 cm × 7 cm × 5 cm large subcutaneous mass was on the anterior chest wall and contrast enhanced computed tomography of the chest demonstrated loculated empyema with extension through the chest wall, into the anterior with rib destruction. Microscopic appearance of the abscess revealed filamentous branching rods, and eventually Nocardia farcinica was identified using Matrix-Assisted Laser Desorption Ionization-Time of Flight. The patient was successfully treated with trimethoprim/sulfamethoxazole and subcutaneous debridement. In general, Mycobacterium tuberculosis and Actinomyces spp. are the most common causative pathogens of empyema necessitans, and cases of Nocardia spp. are rarely seen. Clinicians should pay attention to the possibility of nocardial empyema necessitans in immunocompromised patients.
一名84岁因丙型肝炎导致严重肝硬化的女性，前胸壁进行性膨隆两周。检查发现前胸壁有一个7厘米×7厘米×5厘米大的皮下肿块，胸部增强计算机断层扫描显示有局限性脓胸，脓胸延伸穿过胸壁至前方，伴有肋骨破坏。脓肿的显微镜检查显示为丝状分支杆菌，最终通过基质辅助激光解吸电离飞行时间质谱鉴定为鼻疽诺卡菌。患者接受甲氧苄啶/磺胺甲恶唑治疗及皮下清创后成功治愈。一般来说，结核分枝杆菌和放线菌属是脓性肌炎最常见的致病病原体，诺卡菌属病例很少见。临床医生应注意免疫功能低下患者发生诺卡菌性脓性肌炎的可能性。
