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病例报告:肝移植术后早期的鼻疽诺卡菌肺炎

Case report: Nocardia farcinica pneumonia in early-stage post liver transplantation.

作者信息

Pan Bing, Wang Fang-Fei, He Qiang

机构信息

Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

Front Med (Lausanne). 2022 Sep 7;9:996045. doi: 10.3389/fmed.2022.996045. eCollection 2022.

Abstract

BACKGROUND

Liver transplantation is a well-established treatment for end-stage liver disease. The evolution of immunosuppressants has supported the recent advances in this field. However, this leads to immunosuppression and increases the risk for infections. Nocardia is an aerobic gram-positive bacillus, which can cause multi-systemic or multi-organ infections. Nocardia is an opportunistic pathogen that principally affects immunosuppressed patients.

CASE PRESENTATION

Herein, we present a case of Nocardia farcinica pneumonia in a patient at early-stage post-liver transplantation. Following appropriate microbiological tests and imaging, the diagnosis was finally confirmed. A full recovery was achieved after optimal antibiotic therapy of sulfamethoxazole, minocycline, and amikacin.

CONCLUSIONS

Nocardia farcinica pneumonia is a rare and life-threatening disease, especially in patients after liver transplantation. Imaging and microbiological tests are helpful for the early diagnosis of the disease. Trimethoprim-sulfamethoxazole (TMP-SMX) as part of first-line therapy for nocardiosis is recommended.

摘要

背景

肝移植是终末期肝病的一种成熟治疗方法。免疫抑制剂的发展推动了该领域的最新进展。然而,这会导致免疫抑制并增加感染风险。诺卡菌是一种需氧革兰氏阳性杆菌,可引起多系统或多器官感染。诺卡菌是一种机会性病原体,主要影响免疫抑制患者。

病例报告

在此,我们报告一例肝移植术后早期患者发生的豚鼠耳炎诺卡菌肺炎。经过适当的微生物学检查和影像学检查,最终确诊。经磺胺甲恶唑、米诺环素和阿米卡星的最佳抗生素治疗后实现了完全康复。

结论

豚鼠耳炎诺卡菌肺炎是一种罕见且危及生命的疾病,尤其是在肝移植患者中。影像学和微生物学检查有助于该疾病的早期诊断。推荐使用复方新诺明(TMP-SMX)作为诺卡菌病一线治疗的一部分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a271/9490265/16c7b8292ec5/fmed-09-996045-g0001.jpg

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